Provider Demographics
NPI:1447263686
Name:PEAK PERFORMANCE THERAPY, P.C.
Entity type:Organization
Organization Name:PEAK PERFORMANCE THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT OCS CMPT
Authorized Official - Phone:970-728-1888
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3178
Mailing Address - Country:US
Mailing Address - Phone:970-728-1888
Mailing Address - Fax:
Practice Address - Street 1:300 W. COLORADO AVE
Practice Address - Street 2:UNIT 2B
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-3178
Practice Address - Country:US
Practice Address - Phone:970-728-1888
Practice Address - Fax:970-369-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCD2303OtherMEDICARE PTAN