Provider Demographics
NPI:1124243621
Name:PEAK PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:PEAK PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:989-681-6462
Mailing Address - Street 1:141 FOX PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-9747
Mailing Address - Country:US
Mailing Address - Phone:989-681-6462
Mailing Address - Fax:989-681-6462
Practice Address - Street 1:141 FOX PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-9747
Practice Address - Country:US
Practice Address - Phone:989-681-6462
Practice Address - Fax:989-681-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID NUMBER