Healthcare Provider Details

I. General information

NPI: 1174441703
Provider Name (Legal Business Name): PEAK FORM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 W 38TH AVE STE 100
WHEAT RIDGE CO
80033-4341
US

IV. Provider business mailing address

1260 E 1ST AVE
BROOMFIELD CO
80020-3792
US

V. Phone/Fax

Practice location:
  • Phone: 303-655-9005
  • Fax: 833-906-2577
Mailing address:
  • Phone: 303-655-9005
  • Fax: 833-906-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA OCONNOR
Title or Position: ADMINISTRATIVE ASSISTANT
Credential: ADMINISTRATION
Phone: 303-655-9005