MEDICARE: PEAKS SPORTS & SPINE PHYSICAL THERAPY

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		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346285947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAKS SPORTS & SPINE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	801 W DAVIS ST
Second Line	:	SUITE 103
City	:	CLE ELUM
State	:	WA
Zip	:	98922-1086
Country	:	US
Telephone Number	:	509-674-2526
Fax Number	:	509-674-2516

Provider Business Practice Location Address
First Line	:	801 W DAVIS ST
Second Line	:	SUITE 103
City	:	CLE ELUM
State	:	WA
Zip	:	98922-1086
Country	:	US
Telephone Number	:	509-674-2526
Fax Number	:	509-674-2516

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. BRAD CALLAN
Credential	:	MSPT
Telephone Number	:	509-674-2526

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/22/2020

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Directions to “PEAKS SPORTS & SPINE PHYSICAL THERAPY ” Practice Location

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