Provider Demographics
NPI:1720564859
Name:PEAK, JASON JEREMY
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JEREMY
Last Name:PEAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4203
Mailing Address - Country:US
Mailing Address - Phone:602-388-7461
Mailing Address - Fax:
Practice Address - Street 1:400 N WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4203
Practice Address - Country:US
Practice Address - Phone:602-388-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48704225200000X
CAPTA48704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant