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1992205512

NPI Code Detail

MEDICARE: PEAK WELLNESS INSTITUTE

MEDICARE: PEAK WELLNESS INSTITUTE

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	174400000X	Specialist	L15479R	LA
2	208100000X	Physical Medicine & Rehabilitation Physician		AZ
3	208VP0000X	Pain Medicine Physician	D01889748	AZ
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	50572	AZ

General Provider Information

NPI Number	:	1992205512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK WELLNESS INSTITUTE

Provider Business Mailing Address
First Line	:	20950 N TATUM BLVD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4204
Country	:	US
Telephone Number	:	480-222-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	20950 N TATUM BLVD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4204
Country	:	US
Telephone Number	:	480-222-7246
Fax Number	:

Authorized Official
Title or Position	:	OFFICE
Name	:	DEANNA M CONNER
Credential	:
Telephone Number	:	623-238-8424

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “PEAK WELLNESS INSTITUTE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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