Provider Demographics
NPI:1700676921
Name:PEAK REHAB MEDICINE, LLC
Entity type:Organization
Organization Name:PEAK REHAB MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELORTONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-335-5644
Mailing Address - Street 1:1508 ASPENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 ASPENWOOD LN
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8759
Practice Address - Country:US
Practice Address - Phone:720-335-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty