Healthcare Provider Details

I. General information

NPI: 1154433456
Provider Name (Legal Business Name): PEAK REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 CIRCLE DR
WHITE PINE TN
37890-3306
US

IV. Provider business mailing address

PO BOX 1167
WHITE PINE TN
37890-1167
US

V. Phone/Fax

Practice location:
  • Phone: 865-919-0029
  • Fax:
Mailing address:
  • Phone: 865-919-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0000003965
License Number StateTN

VIII. Authorized Official

Name: ROBB SEAHORN
Title or Position: PRESIDENT
Credential: PT CSCS
Phone: 865-919-0029