Provider Demographics
NPI:1871581058
Name:PEAK PERFORMANCE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-542-0808
Mailing Address - Street 1:1940 HARVE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8332
Mailing Address - Country:US
Mailing Address - Phone:406-542-0808
Mailing Address - Fax:
Practice Address - Street 1:1940 HARVE AVE
Practice Address - Street 2:STE2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8332
Practice Address - Country:US
Practice Address - Phone:406-542-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1760174288Medicaid
MT1083346506Medicaid
MT1366282436Medicaid
MT1063439024Medicaid
MT1215530159Medicaid
MT1407085640Medicaid
MT1194370270Medicaid
MT8822411Medicaid