Organization
PEAK PHYSICAL THERAPY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIN TUCKER PTA (OWNER)
(208) 375-0666
Entity
Organization
Contact information
Practice address
7550 W EMERALD ST # 101, BOISE, ID 83704-9015
(208) 375-0666
(208) 375-2996
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
(812) 628-3060
(208) 375-2996
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142952
BLUE SHIELD OF IDAHO
ID
05
—
806711000
—
ID
01
—
CK8839
RAIL ROAD MEDICARE
ID
01
—
T8059
BLUE CROSS OF IDAHO
ID
Enumeration date
06/04/2006
Last updated
10/27/2022
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