Provider Demographics
NPI:1346469335
Name:PECK, JUDITH R (PT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:R
Last Name:PECK
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Gender:F
Credentials:PT
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Mailing Address - Street 1:1230 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6450
Mailing Address - Country:US
Mailing Address - Phone:909-825-6716
Mailing Address - Fax:909-825-4339
Practice Address - Street 1:802 MAGNOLIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3104
Practice Address - Country:US
Practice Address - Phone:951-340-0070
Practice Address - Fax:951-340-9188
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT5612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist