MEDICARE: PEAK PELVIC HEALTH

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	:	1487370144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PELVIC HEALTH

Provider Business Mailing Address
First Line	:	3419 WIND WAKER WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5226
Country	:	US
Telephone Number	:	719-651-6101
Fax Number	:

Provider Business Practice Location Address
First Line	:	3419 WIND WAKER WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5226
Country	:	US
Telephone Number	:	719-651-6101
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	MALLORY WILLIS
Credential	:	PT
Telephone Number	:	719-651-6101

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	10/14/2022

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