Healthcare Provider Details

I. General information

NPI: 1083075386
Provider Name (Legal Business Name): JOEL PECK PT, DPT,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 DOUBLE DIAMOND PKWY STE 100
RENO NV
89521-5844
US

IV. Provider business mailing address

9480 DOUBLE DIAMOND PKWY STE 100
RENO NV
89521-5844
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-1600
  • Fax: 775-786-7706
Mailing address:
  • Phone: 775-786-1600
  • Fax: 776-786-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0851
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: