Healthcare Provider Details

I. General information

NPI: 1578997144
Provider Name (Legal Business Name): KATHLEEN JO PEAVEY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN JO ORESKOVIC PT,DPT

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W BUTLER RD
GREENVILLE SC
29607-4890
US

IV. Provider business mailing address

217 DEVON DR
MAULDIN SC
29662-1915
US

V. Phone/Fax

Practice location:
  • Phone: 864-757-9918
  • Fax: 864-757-9921
Mailing address:
  • Phone: 317-902-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number7092
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: