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General NPI Number Information
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NPI Number | 1780731992
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE PHYSICAL THERAPY AND FITNESS
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 23 SOUTH MAIN STREET
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City | COALVILLE
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State | UT
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Zip | 84017
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Country | US
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Telephone | 435-654-3719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 307
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City | BOUNTIFUL
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State | UT
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Zip | 84011-0307
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Country | US
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Telephone | 888-700-6907
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Fax | 801-294-6917
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Authorized Official
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Title or Position | OWNER
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Name | RODNEY EDWARD WADE
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Credential | PT
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Telephone | 435-654-3719
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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 | 5327836-2401
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License Number State | UT
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