Provider Demographics
NPI:1528460482
Name:PEAK HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:PEAK HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:801-689-3389
Mailing Address - Street 1:2850 N 2000 W
Mailing Address - Street 2:#203
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9219
Mailing Address - Country:US
Mailing Address - Phone:801-689-3389
Mailing Address - Fax:801-689-2320
Practice Address - Street 1:2850 N 2000 W
Practice Address - Street 2:#203
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9219
Practice Address - Country:US
Practice Address - Phone:801-689-3389
Practice Address - Fax:801-689-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT46D2083659291U00000X, 291U00000X
UT6801881-1206261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory