Peak Performance Physical Therapy, PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5080663-2401 Issued in UT

Legal business name

PEAK PERFORMANCE PHYSICAL THERAPY, PC

Doing business as

Peak Performance Sports Medicine

Practice address

2760 Rasmussen Rd
D2-D3
Park City, UT 84098-5684

Phone

(801) 718-5378

NPI assigned

Apr 18, 2014

Last updated

May 1, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jessica Jacobsen Tidswell, PT, DPT, SCS, ATCNPI 1952593568

Title

President

Phone

(801) 718-5378

Specialties & licenses 1

Addresses

Other names 1

• Peak Performance Sports Medicine Doing business as

Practitioners 1

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.

• Jessica J Tidswell, PT, DPT, SCS, ATC

  • Physical Therapist
  • Park City, UT
  • NPI 1952593568
  NPD (past) Authorized official

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398902400000",
    "number": "1073933966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ASPEN DRIVE",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "84098",
            "telephone_number": "801-718-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 RASMUSSEN RD",
            "address_2": "D2-D3",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985684",
            "telephone_number": "801-718-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PERFORMANCE PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-18",
        "last_updated": "2014-05-01",
        "status": "A",
        "authorized_official_last_name": "TIDSWELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "JACOBSEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-718-5378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, SCS, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "UT",
            "license": "5080663-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Performance Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia a Lindsay PHD Inc
• Paul Innis DMD Inc
• Matthew Paul
• PC Pharmacy at the Clinic Inc (Park City Phcy at the Clinic)
• Penny Jean Peacock, M.D.
• Steven Pearmain, PA.C
• Thomas Roger Peay, PH.D.
• Wade A Peers, D.D.S.
• Robert Eugene Pellegrine, MD
• Vannette Perkins, MD

• Physical Therapy Clinic/Center in Park City, UT
• Providers in Park City, UT by specialty
• Physical Therapy Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.