Healthcare Provider Details

I. General information

NPI: 1699301200
Provider Name (Legal Business Name): PEAK PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 03/14/2020
Certification Date: 03/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 ROSETTE DR NW
ALBUQUERQUE NM
87120-5280
US

IV. Provider business mailing address

7520 ROSETTE DR NW
ALBUQUERQUE NM
87120-5280
US

V. Phone/Fax

Practice location:
  • Phone: 505-206-1148
  • Fax:
Mailing address:
  • Phone: 505-206-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ETHAN TERRY STOCKTON
Title or Position: PHYSICAL THERAPIST/SOLE MEMBER
Credential: DPT
Phone: 505-206-1148