Provider Demographics
NPI:1083075386
Name:PECK, JOEL (PT, DPT,)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:PT, DPT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 DOUBLE DIAMOND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5844
Mailing Address - Country:US
Mailing Address - Phone:775-786-1600
Mailing Address - Fax:776-786-7706
Practice Address - Street 1:9480 DOUBLE DIAMOND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5844
Practice Address - Country:US
Practice Address - Phone:775-786-1600
Practice Address - Fax:775-786-7706
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV08512251X0800X
NV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist