Provider Demographics
NPI:1972713329
Name:THERAPEAK, INC.
Entity type:Organization
Organization Name:THERAPEAK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BROZOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-264-6781
Mailing Address - Street 1:4001 S 700 E
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2177
Mailing Address - Country:US
Mailing Address - Phone:801-264-6781
Mailing Address - Fax:801-264-6782
Practice Address - Street 1:4001 S 700 E
Practice Address - Street 2:SUITE 500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2177
Practice Address - Country:US
Practice Address - Phone:801-264-6781
Practice Address - Fax:801-264-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4726255320012251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
UT=========001Medicaid
NV37288Medicare ID - Type UnspecifiedPT GROUP
IL205185Medicare ID - Type UnspecifiedOT GROUP
IN156610Medicare ID - Type UnspecifiedPT GROUP
IN156610Medicare ID - Type UnspecifiedOT GROUP
NV37288Medicare ID - Type UnspecifiedOT GROUP
IL=========Medicaid