Eli Peckham, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

930 SW Hall St
Portland, OR 97201

Phone

(206) 295-7320

NPI assigned

Feb 8, 2018

Last updated

Jun 15, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1063911758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SE OLYMPIA DR APT 120",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SW HALL ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97201",
            "telephone_number": "206-295-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "ELI",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-08",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Joann Peck, DPT
• Gretli Peck, MSW
• James J Peck, M.D.
• Julia Grace Peck, BA
• Regina Peck
• Scott Westley Pecora, N.P.
• Anders Pecore
• Pedal PT, LLC (Pedal PT)
• Ali Elizabeth Pedego, PH.D., BCBA-D
• Marisa Quijano Peden, LMT

• Athletic Trainer in Portland, OR
• Providers in Portland, OR by specialty
• Athletic Trainer in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.