Provider Demographics
NPI:1568958593
Name:PEAGLER, PATRICK R (ATC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:PEAGLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-4620
Mailing Address - Country:US
Mailing Address - Phone:334-368-4270
Mailing Address - Fax:
Practice Address - Street 1:819 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-4620
Practice Address - Country:US
Practice Address - Phone:334-368-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19412083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine