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General NPI Number Information
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NPI Number | 1205021276
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Entity Type | Organization
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Legal Business Name | PEAK ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 14841 179TH AVE SE SUITE 340
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City | MONROE
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State | WA
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Zip | 98272-1127
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Country | US
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Telephone | 360-794-7520
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Fax | 360-794-8947
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Provider Business Mailing Address
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Address Line | 14841 179TH AVE SE SUITE 340
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City | MONROE
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State | WA
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Zip | 98272-1127
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Country | US
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Telephone | 360-794-7520
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Fax | 360-794-8947
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN J RUSSON
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Credential | MS PT ATC
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Telephone | 360-794-7520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT0000754
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License Number State | WA
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