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

General Provider Information

NPI Number	:	1124243621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	141 FOX PL
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9747
Country	:	US
Telephone Number	:	989-681-6462
Fax Number	:	989-681-6462

Provider Business Practice Location Address
First Line	:	141 FOX PL
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9747
Country	:	US
Telephone Number	:	989-681-6462
Fax Number	:	989-681-6462

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	MR. JAMES RANDOLPH TILTON JR.
Credential	:	P.T.
Telephone Number	:	989-681-6462

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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