Provider Demographics
NPI:1023865078
Name:PEAK WELLNESS AND AESTHETICS LLC
Entity type:Organization
Organization Name:PEAK WELLNESS AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:757-312-9444
Mailing Address - Street 1:221 MOUNT PLEASANT RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4155
Mailing Address - Country:US
Mailing Address - Phone:757-312-9444
Mailing Address - Fax:757-447-3500
Practice Address - Street 1:221 MOUNT PLEASANT RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4155
Practice Address - Country:US
Practice Address - Phone:757-312-9444
Practice Address - Fax:757-447-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty