Healthcare Provider Details

I. General information

NPI: 1669639043
Provider Name (Legal Business Name): PEAK MOTION PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 HOLLY AVE. NE
ALBUQUERQUE NM
87113
US

IV. Provider business mailing address

8100 WYOMING BLVD NE STE M4 261
ALBUQUERQUE NM
87113-1963
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-5505
  • Fax: 505-797-5510
Mailing address:
  • Phone: 505-797-5505
  • Fax: 505-797-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2401
License Number StateNM

VIII. Authorized Official

Name: PHILIP MARTIN BACA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 505-797-5505