NPIMap

Organization Active NPI

Peak Performance Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Missoula, MT
National Provider Identifier
1871581058
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PEAK PERFORMANCE PHYSICAL THERAPY PC
Practice address
1940 Harve Ave
Ste2
Missoula, MT 59801-8332
Phone
(406) 542-0808
NPI assigned
Oct 11, 2005
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Jill Anne OlsonNPI 1770544421
Title
Owner
Phone
(406) 542-0808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X
Clinic/Center 261Q00000X
Physical Therapy Clinic/Center 261QP2000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1940 Harve Ave
Ste2
Missoula, MT 59801-8332

Mailing address

1940 Harve Ave
Ste 2
Missoula, MT 59801-8332
Phone (406) 542-0808

Other identifiers 8

IdentifierTypeStateIssuer
1760174288MedicaidMT
1083346506MedicaidMT
1366282436MedicaidMT
1063439024MedicaidMT
1215530159MedicaidMT
1407085640MedicaidMT
1194370270MedicaidMT
8822411MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000779 MT Part B Supplier - Clinic/Group Practice 5395644256 Receives reassigned benefits from 9 practitioners
Practice locations: Missoula, MT

National Provider Directory

National Provider Directory

Locations

125 South Ave W
Missoula, MT 59801
Phone (406) 542-0808

1940 Harve Ave
Ste 2
Missoula, MT 59801
Phone (406) 531-4954

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1871581058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 HARVE AVE",
            "address_2": "STE 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018332",
            "telephone_number": "406-542-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 HARVE AVE",
            "address_2": "STE2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018332",
            "telephone_number": "406-542-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PERFORMANCE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-542-0808"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760174288",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083346506",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366282436",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063439024",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215530159",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407085640",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194370270",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8822411",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.