Healthcare Provider Details

I. General information

NPI: 1932791837
Provider Name (Legal Business Name): PEAKLIFE REHAB AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 1/2 MISSOURI AVE
DEER LODGE MT
59722-1076
US

IV. Provider business mailing address

307 1/2 MISSOURI AVE
DEER LODGE MT
59722-1076
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-3448
  • Fax:
Mailing address:
  • Phone: 406-846-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANA BECK
Title or Position: OWNER
Credential: PT
Phone: 406-846-3448