Provider Demographics
NPI:1265653794
Name:PEACOCK, REBECCA ANN (PT, MPT, ATP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PT, MPT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 JACKSON ST
Mailing Address - Street 2:STE 400
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3250
Mailing Address - Country:US
Mailing Address - Phone:281-344-8900
Mailing Address - Fax:281-344-8926
Practice Address - Street 1:117 NORTHERN STAR
Practice Address - Street 2:
Practice Address - City:BRUCEVILLE
Practice Address - State:TX
Practice Address - Zip Code:76630-3282
Practice Address - Country:US
Practice Address - Phone:254-857-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114700225100000X, 2251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics