Provider Demographics
NPI:1780350223
Name:PECK, ROBERT VICTOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:VICTOR
Last Name:PECK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518A KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5925
Mailing Address - Country:US
Mailing Address - Phone:317-910-5996
Mailing Address - Fax:
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4576
Practice Address - Country:US
Practice Address - Phone:615-370-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT.61228639225100000X
VA2305214545225100000X
TNCP014520T225100000X
TN14589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist