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General NPI Number Information
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NPI Number | 1376497958
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Entity Type | Organization
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Legal Business Name | PEAK WILDERNESS AND SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1800 HERITAGE BLVD
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City | MIDLAND
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State | TX
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Zip | 79707-9750
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Country | US
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Telephone | 432-520-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 10 DEER RUN DR
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City | ALPINE
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State | TX
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Zip | 79830-5156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | HEATHER FULLERTON
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Credential | MD
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Telephone | 512-721-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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