Provider Demographics
NPI:1780625137
Name:PEAK, LORI HARTMAN (DPT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:HARTMAN
Last Name:PEAK
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:1030 MALL LOOP RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7656
Practice Address - Country:US
Practice Address - Phone:336-781-4320
Practice Address - Fax:336-781-4231
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005662225100000X
NCP23536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2281002OtherFIRST HEALTH
VA2429864OtherUNITED HEALTHCARE
VA284203OtherSOUTHERN HEALTH
VA364553080OtherTRICARE
VA137660OtherBC/BS ANTHEM
VATN0100OtherJOHN DEERE HEALTH
VA7559448OtherAETNA
VAP00194716OtherRAILROAD MEDICARE
VAP00194716OtherRAILROAD MEDICARE