Peak Form LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PEAK FORM LLC

Practice address

1260 E 1St Ave
Broomfield, CO 80020-3792

Phone

(303) 655-9005

NPI assigned

Aug 2, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Patricia Oconnor

Title

Front Desk Coordinator

Phone

(303) 655-9005

Specialties & licenses 6

Addresses

Other names 2

• Peak Form Medical Clinic Doing business as
• Peak Form Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Brighton, CO
  • NPI 1811018914

  O20120831000550

  Same enrollment
• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Greeley, CO
  • NPI 1851113385

  O20120831000550

  Same enrollment
• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Boulder, CO
  • NPI 1982718003

  O20120831000550

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Peak Form LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Peak Form LLC

  • Occupational Medicine Physician
  • Wheat Ridge, CO
  • NPI 1174441703
  NPD tax ID
• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Brighton, CO
  • NPI 1811018914
  NPD tax ID
• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Greeley, CO
  • NPI 1851113385
  NPD tax ID
• Peak Form LLC

  • Physical Medicine & Rehabilitation Physician
  • Boulder, CO
  • NPI 1982718003
  NPD tax ID

Locations

Practitioners 3

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

• Joe R Schroeder, DPT

  • Physical Therapist
  • Windsor, CO
  • NPI 1104164953
  NPD
• Stephanie Ann Hansen, PT, DPT

  • Physical Therapist
  • Broomfield, CO
  • NPI 1659628105
  NPD (past)
• Brittany Michelle Seale, PT, DPT

  • Physical Therapist
  • Broomfield, CO
  • NPI 1578347282
  NPD (past)

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1831863117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 E BRIDGE ST",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806012252",
            "telephone_number": "303-655-9005",
            "fax_number": "303-655-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 E 1ST AVE",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800203792",
            "telephone_number": "303-655-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK FORM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "FRONT DESK COORDINATOR",
        "authorized_official_telephone_number": "303-655-9005",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Exercise Physiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Form Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peak Form Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peak Form Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lori Parr, RDH
• Carlie Ann Pataska, COTA
• Pathways to Speech and Reading LLC
• Van Pavlik, PT
• Keegan Payne
• Peak Voice and Airway Center PLLC
• Peak Voice, LLC
• Amber W. Pearson, MA, LPC
• Charles A Peck, MD
• Mary Jayne Pedersen, RN. BSN.

• Physical Medicine & Rehabilitation Physician in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Physical Medicine & Rehabilitation Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.