Healthcare Provider Details

I. General information

NPI: 1851508766
Provider Name (Legal Business Name): KIRK MICHAEL PECK PT, PH.D, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 J ST
OMAHA NE
68107-1643
US

IV. Provider business mailing address

3514 CALIFORNIA ST
OMAHA NE
68131-1910
US

V. Phone/Fax

Practice location:
  • Phone: 402-733-3612
  • Fax: 402-733-3487
Mailing address:
  • Phone: 402-344-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number999
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: