Provider Demographics
NPI:1154433456
Name:PEAK REHAB
Entity type:Organization
Organization Name:PEAK REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBB
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAHORN
Authorized Official - Suffix:
Authorized Official - Credentials:PT CSCS
Authorized Official - Phone:865-919-0029
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-1167
Mailing Address - Country:US
Mailing Address - Phone:865-919-0029
Mailing Address - Fax:
Practice Address - Street 1:3108 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3306
Practice Address - Country:US
Practice Address - Phone:865-919-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003965261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy