Provider Demographics
NPI:1598723744
Name:PEAKE, GREGORY TODD (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:PEAKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 VALLEY PLZ
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1046
Mailing Address - Country:US
Mailing Address - Phone:607-729-2200
Mailing Address - Fax:607-729-2202
Practice Address - Street 1:800 VALLEY PLZ
Practice Address - Street 2:SUITE 9
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1046
Practice Address - Country:US
Practice Address - Phone:607-729-2200
Practice Address - Fax:607-729-2202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017381-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist