Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1114700 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1114700 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1114700 | TX |
NPI | 1265653794 |
---|---|
Provider Name | Mrs. Rebecca Ann Peacock |
First Address | Richmond, TX 77469-3250 |
Second Address | Bruceville, TX 76630-3282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 26/06/2018 |