Peak Orthopedic & Sports Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT0000754 Issued in WA

Legal business name

PEAK ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC

Practice address

14841 179TH Ave SE
Suite 340
Monroe, WA 98272-1127

Phone

(360) 794-7520

Fax

(360) 794-8947

NPI assigned

Sep 12, 2007

Organization subpart

No

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

Authorized official

Name

Brian J Russon, MS PT ATCNPI 1295731594

Title

Owner

Phone

(360) 794-7520

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Joseph Russon, M.S.P.T.ATC

  • Physical Therapist
  • Monroe, WA
  • NPI 1295731594
  Medicare reassignment NPD Authorized official
• Robert Green, PTA

  • Physical Therapy Assistant
  • Monroe, WA
  • NPI 1881574978
  NPD

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1205021276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14841 179TH AVE SE",
            "address_2": "SUITE 340",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721127",
            "telephone_number": "360-794-7520",
            "fax_number": "360-794-8947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14841 179TH AVE SE",
            "address_2": "SUITE 340",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721127",
            "telephone_number": "360-794-7520",
            "fax_number": "360-794-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "RUSSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-794-7520",
        "authorized_official_credential": "MS PT ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "PT0000754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7116288",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Poonam Patel
• Kristi Patricelli, LMP
• Ryan Q Patterson, M.A. LMHC
• John D Patz, DO
• Alondra Paz Cruz
• Lee T Pearson, LMP
• A Chancellor Pell, PA-C
• Daniel L Peltonen, DC
• James Michael Pesta Jr., LMP
• Timothy James Peterson, MA, LMHCA

• Physical Therapy Clinic/Center in Monroe, WA
• Providers in Monroe, WA by specialty
• Physical Therapy Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.