Provider Demographics
NPI:1831480219
Name:PECK, LINDA ANNA (CMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANNA
Last Name:PECK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 DOMINION AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3418
Mailing Address - Country:US
Mailing Address - Phone:757-576-0182
Mailing Address - Fax:
Practice Address - Street 1:3323 DOMINION AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3418
Practice Address - Country:US
Practice Address - Phone:757-576-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist