Provider Demographics
NPI:1457635880
Name:PEACOCK, MEAGAN ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:PEACOCK
Suffix:
Gender:F
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 1:561 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8563
Mailing Address - Country:US
Mailing Address - Phone:704-667-8470
Mailing Address - Fax:704-667-8471
Practice Address - Street 1:561 N POLK ST
Practice Address - Street 2:CAROLINAS HEALTHCARE SYSTEM PINEVILLE PEDIATRIC THERAPY
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8563
Practice Address - Country:US
Practice Address - Phone:704-667-8470
Practice Address - Fax:704-667-8471
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist