Healthcare Provider Details

I. General information

NPI: 1710343595
Provider Name (Legal Business Name): PEAK SPA AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7967 GLADWATER RD
PEYTON CO
80831-6067
US

IV. Provider business mailing address

7967 GLADWATER RD
PEYTON CO
80831-6067
US

V. Phone/Fax

Practice location:
  • Phone: 719-232-2653
  • Fax: 719-283-3367
Mailing address:
  • Phone: 719-232-2653
  • Fax: 719-283-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEANDRA JACKSON
Title or Position: OWNER
Credential:
Phone: 719-392-4658