Provider Demographics
NPI:1063656072
Name:PEAKE, JENNIFER BESSINGER (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BESSINGER
Last Name:PEAKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUMMIT TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7639
Mailing Address - Country:US
Mailing Address - Phone:803-736-1577
Mailing Address - Fax:803-736-1578
Practice Address - Street 1:3 SUMMIT TER
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7639
Practice Address - Country:US
Practice Address - Phone:803-736-1577
Practice Address - Fax:803-736-1578
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1629225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant