Provider Demographics
NPI:1891959334
Name:PEACOCK, JANINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-1066
Mailing Address - Country:US
Mailing Address - Phone:240-718-8103
Mailing Address - Fax:
Practice Address - Street 1:11813 PARK WALDORF LN STE 522
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3191
Practice Address - Country:US
Practice Address - Phone:240-718-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist