Provider Demographics
NPI:1356759476
Name:PEACOCK, ALICIA J (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:J
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:690 S COOPER RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5900
Practice Address - Country:US
Practice Address - Phone:480-503-2100
Practice Address - Fax:480-503-2131
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11071225100000X
AZLPT011071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist