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General NPI Number Information
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NPI Number | 1831572759
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Entity Type | Organization
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Legal Business Name | THE PEAK PHYSICAL MEDICINE
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 2955 PROFESSIONAL PL STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-8140
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Country | US
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Telephone | 719-591-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 2955 PROFESSIONAL PL STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-8140
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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 | OWNER
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Name | TIMOTHY VAUGHN SANDELL
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Credential | M.D.
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Telephone | 719-591-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 34408
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License Number State | CO
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