Provider Demographics
NPI:1134315963
Name:PEACOCK, LORI L (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HICKORY RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1047
Mailing Address - Country:US
Mailing Address - Phone:800-879-4471
Mailing Address - Fax:610-834-7525
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:610-834-7525
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013686L174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist