Healthcare Provider Details

I. General information

NPI: 1871581058
Provider Name (Legal Business Name): PEAK PERFORMANCE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARVE AVE STE2
MISSOULA MT
59801-8332
US

IV. Provider business mailing address

1940 HARVE AVE STE 2
MISSOULA MT
59801-8332
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-0808
  • Fax:
Mailing address:
  • Phone: 406-542-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL ANNE OLSON
Title or Position: OWNER
Credential:
Phone: 406-542-0808