MEDICARE: MR. SHARIK L PECK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	RPT-1264	ID
2	174400000X	Specialist	275801-2401	UT

General Provider Information

NPI Number	:	1346342110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHARIK L PECK PT

Provider Business Mailing Address
First Line	:	405 S 200 W
Second Line	:
City	:	RICHMOND
State	:	UT
Zip	:	84333-1267
Country	:	US
Telephone Number	:	435-258-5601
Fax Number	:	435-258-4545

Provider Business Practice Location Address
First Line	:	405 S 200 W
Second Line	:
City	:	RICHMOND
State	:	UT
Zip	:	84333-1267
Country	:	US
Telephone Number	:	435-258-5601
Fax Number	:	435-258-4545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	11/19/2010

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Directions to “ MR. SHARIK L PECK PT” Practice Location

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