NPIMap

Organization Active NPI

Peak Physical Therapy & Sports Medicine of Wylie

  • Physical Therapist
  • Wylie, TX
National Provider Identifier
1932131455
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1152490 Issued in TX
Legal business name
PEAK PHYSICAL THERAPY & SPORTS MEDICINE OF WYLIE
Practice address
611 W Brown St Ste 101
Wylie, TX 75098-5816
Phone
(972) 442-5287
Fax
(972) 442-3181
NPI assigned
Jul 7, 2006
Last updated
Dec 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

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

Authorized official

Name
Mr. Edward Richard Broad, MPTNPI 1235152117
Title
Owner/Director/Therapist
Phone
(972) 442-5287

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1152490 TX Primary

Addresses

Primary practice location

611 W Brown St Ste 101
Wylie, TX 75098-5816

Mailing address

611 W Brown St Ste 101
Wylie, TX 75098-5816
Phone (972) 442-5287

Other identifiers 2

IdentifierTypeStateIssuer
0021MJOtherTXBCBS GROUP #
DD3715OtherTXMEDICARE RAILROAD GROUP #

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262131200000",
    "number": "1932131455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W BROWN ST STE 101",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750985816",
            "telephone_number": "972-442-5287",
            "fax_number": "972-442-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W BROWN ST STE 101",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750985816",
            "telephone_number": "972-442-5287",
            "fax_number": "972-442-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PHYSICAL THERAPY & SPORTS MEDICINE OF WYLIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2009-12-30",
        "status": "A",
        "authorized_official_last_name": "BROAD",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER/DIRECTOR/THERAPIST",
        "authorized_official_telephone_number": "972-442-5287",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1152490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "0021MJ",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP #",
            "identifier": "DD3715",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wylie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; 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.