MEDICARE: PEAK PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PE647283	OTHER	CO	BLUE CROSS

General Provider Information

NPI Number	:	1053441634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	427 W MAIN ST
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-3033
Country	:	US
Telephone Number	:	970-522-7743
Fax Number	:	970-522-8835

Provider Business Practice Location Address
First Line	:	190 TALISMAN DR
Second Line	:	UNIT D4
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9171
Country	:	US
Telephone Number	:	970-731-1888
Fax Number	:	970-731-1889

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK I MCDONALD
Credential	:	DPT
Telephone Number	:	970-522-7743

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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Directions to “PEAK PHYSICAL THERAPY INC ” Practice Location

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