Provider Demographics
NPI: | 1134691504 |
---|---|
Name: | PEACOCK, MATTHEW DOUGLAS (PT, DPT) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | DOUGLAS |
Last Name: | PEACOCK |
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: | 1305 E ELM ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HILLSBORO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76645-2645 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 254-582-2713 |
Mailing Address - Fax: | 254-582-2717 |
Practice Address - Street 1: | 1305 E ELM ST |
Practice Address - Street 2: | |
Practice Address - City: | HILLSBORO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76645-2645 |
Practice Address - Country: | US |
Practice Address - Phone: | 254-582-2713 |
Practice Address - Fax: | 254-582-2717 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-12-26 |
Last Update Date: | 2023-09-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 1253926 | 2251C2600X, 2251E1200X, 2251E1300X, 2251G0304X, 2251H1200X, 2251H1300X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X, 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 2251E1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |