NPIMap

Organization Active NPI

Peak Performance Therapy Services P C

  • Physical Therapist
  • Ammon, ID
National Provider Identifier
1003898974
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PEAK PERFORMANCE THERAPY SERVICES P C
Practice address
3456 E 17TH St
Suite 130
Ammon, ID 83406-6757
Phone
(208) 523-0030
Fax
(208) 523-3828
NPI assigned
Nov 16, 2005
Last updated
Dec 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. P. Briggs Horman, PHYSICAL THERAPIST
Title
Owner/President
Phone
(208) 523-0030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3456 E 17TH St
Suite 130
Ammon, ID 83406-6757

Mailing address

3456 E 17TH St
Suite 130
Ammon, ID 83406-6757
Phone (208) 523-0030

Other identifiers 3

IdentifierTypeStateIssuer
000010152186OtherIDBLUE SHIELD PROVIDER NUMB
807304100MedicaidID
8M467OtherIDBLUE CROSS PROVIDER NUMBE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050518000646 ID Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8123069333 Practice locations: Ammon, ID
O20250521001629 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8123069333 Practice locations: Ammon, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003898974. Details of each certification follow.

  • CCN 136540 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 136540

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PEAK PERFORMANCE THERAPY SERVICE
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Aug 30, 2005
Last certification
Aug 30, 2005
Ownership / control type
Proprietary
Facility address
3456 E 17TH Street, Suite 130
Ammon, ID 83406

National Provider Directory

National Provider Directory

Locations

3456 E 17th St
Ste 130
Ammon, ID 83406
Phone (208) 523-0030

2323 Coronado St
Idaho Falls, ID 83404
Phone (208) 522-5230

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1003898974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3456 E 17TH ST",
            "address_2": "SUITE 130",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066757",
            "telephone_number": "208-523-0030",
            "fax_number": "208-523-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3456 E 17TH ST",
            "address_2": "SUITE 130",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066757",
            "telephone_number": "208-523-0030",
            "fax_number": "208-523-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PERFORMANCE THERAPY SERVICES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "HORMAN",
        "authorized_official_first_name": "P.",
        "authorized_official_middle_name": "BRIGGS",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "208-523-0030",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "000010152186",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807304100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "8M467",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ammon, ID

Sources for this page

Verify at the official NPI Registry.