Organization
PEAK PERFORMANCE PHYSICAL THERAPY AND FITNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY EDWARD WADE PT (OWNER)
(435) 654-3719
Entity
Organization
Contact information
Practice address
23 SOUTH MAIN STREET, COALVILLE, UT 84017
(435) 654-3719
Mailing address
PO BOX 307, BOUNTIFUL, UT 84011-0307
(888) 700-6907
(801) 294-6917
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5327836-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529791445001
—
UT
Enumeration date
01/03/2007
Last updated
11/14/2007
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