Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | NV | |
Y | 2251X0800X | Physical Therapist - Orthopedic | 0851 | NV |
NPI | 1083075386 |
---|---|
Provider Name | Joel Peck |
First Address | Reno, NV 89521-5844 |
Second Address | Reno, NV 89521-5844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2016 |
Last Update Date | 23/02/2018 |