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Organization
PEAK PHYSICAL THERAPY & SPORTS MEDICINE OF WYLIE
Active
Organization
PEAK PHYSICAL THERAPY & SPORTS MEDICINE OF WYLIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD RICHARD BROAD MPT (OWNER/DIRECTOR/THERAPIST)
(972) 442-5287
Entity
Organization
Contact information
Practice address
611 W BROWN ST STE 101, WYLIE, TX 75098-5816
(972) 442-5287
(972) 442-3181
Mailing address
611 W BROWN ST STE 101, WYLIE, TX 75098-5816
(972) 442-5287
(972) 442-3181
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1152490
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021MJ
BCBS GROUP #
TX
01
—
DD3715
MEDICARE RAILROAD GROUP #
TX
Enumeration date
07/07/2006
Last updated
12/30/2009
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