| Organization Name: | PEAK PERFORMANCE PHYSICAL THERAPY, PC |
| NPI Number: | 1073933966 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESSICA JACOBSEN TIDSWELL (PRESIDENT) |
| Mailing Address: | 2760 Rasmussen Rd D2-d3 Park City |
| State: | UT US |
| Postal Code: | 840985684 |
| Phone Number: | 8017185378 |
| Fax Number: | |
| NPI Enumeration Date: | 04/18/2014 |
| NPI Last Update Date: | 05/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5080663-2401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |