# PINE PEAK THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Peak Audiology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982477030
- **Authorized official:** MALLORY ALICE VIG OTR/L (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (218) 435-1210

## Contact information

- **Practice address:** 903 HILLIGOSS BLVD SE, FOSSTON, MN 56542-1541
- **Practice address phone:** (218) 435-1210
- **Practice address fax:** (218) 435-1175
- **Mailing address:** PO BOX 300, FOSSTON, MN 56542-0300
- **Mailing address phone:** (218) 435-1210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 10/31/2023
- **Last updated:** 06/10/2025