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General NPI Number Information
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NPI Number | 1679858591
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Entity Type | Organization
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Legal Business Name | PEAK FITNESS AND PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1915 BROAD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37408-1716
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Country | US
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Telephone | 423-468-4067
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Fax | 423-370-1670
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Provider Business Mailing Address
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Address Line | PO BOX 4744
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City | CHATTANOOGA
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State | TN
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Zip | 37405-0744
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Country | US
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Telephone | 423-468-4067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA A WYKLE
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Credential | PT, DPT, SCS
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Telephone | 423-468-4067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6391
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License Number State | TN
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