Provider Demographics
NPI:1689268393
Name:PEACH TREE REHABILITATION INC
Entity Type:Organization
Organization Name:PEACH TREE REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:845-645-5411
Mailing Address - Street 1:5 BROOKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2100
Mailing Address - Country:US
Mailing Address - Phone:845-645-5411
Mailing Address - Fax:
Practice Address - Street 1:5 BROOKS EDGE DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2100
Practice Address - Country:US
Practice Address - Phone:845-645-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech