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General NPI Number Information
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NPI Number | 1992205512
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Entity Type | Organization
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Legal Business Name | PEAK WELLNESS INSTITUTE
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 20950 N TATUM BLVD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85050-4204
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Country | US
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Telephone | 480-222-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 20950 N TATUM BLVD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85050-4204
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Country | US
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Telephone | 480-222-7246
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Fax |
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Authorized Official
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Title or Position | OFFICE
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Name | DEANNA M CONNER
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Credential |
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Telephone | 623-238-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L15479R
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License Number State | LA
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Taxonomy #2
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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 | AZ
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | D01889748
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 50572
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License Number State | AZ
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