Organization
PEAK PERFORMANCE THERAPY SERVICES P C
Active
Organization
PEAK PERFORMANCE THERAPY SERVICES P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. P. BRIGGS HORMAN PHYSICAL THERAPIST (OWNER/PRESIDENT)
(208) 523-0030
Entity
Organization
Contact information
Practice address
3456 E 17TH ST, SUITE 130, AMMON, ID 83406-6757
(208) 523-0030
(208) 523-3828
Mailing address
3456 E 17TH ST, SUITE 130, AMMON, ID 83406-6757
(208) 523-0030
(208) 523-3828
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152186
BLUE SHIELD PROVIDER NUMB
ID
05
—
807304100
—
ID
01
—
8M467
BLUE CROSS PROVIDER NUMBE
ID
Enumeration date
11/16/2005
Last updated
12/07/2011
Update your record
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