Provider Demographics
NPI:1750827168
Name:PEADEN PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PEADEN PHYSICAL THERAPY, PLLC
Other - Org Name:RESTORE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PEADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-248-0241
Mailing Address - Street 1:3442 HIGH CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-4424
Mailing Address - Country:US
Mailing Address - Phone:850-381-0284
Mailing Address - Fax:
Practice Address - Street 1:3009 HIGHWAY 77 STE O
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5059
Practice Address - Country:US
Practice Address - Phone:850-248-0241
Practice Address - Fax:850-248-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19638261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy