Active NPI
Justin G Peck, PT
- Physical Therapist
- Orlando, FL
National Provider Identifier
1073747317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8726
- Practice address
- 3452 Lake Lynda Dr Ste 200
Orlando, FL 32817-1481 - Phone
- (800) 774-7785
- NPI assigned
- May 13, 2009
- Last updated
- Jan 10, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8726 | CO | Primary |
Addresses
Primary practice location
3452 Lake Lynda Dr Ste 200
Orlando, FL 32817-1481
Mailing address
3452 Lake Lynda Dr Ste 200
Orlando, FL 32817-1481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8726 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578614400000",
"number": "1073747317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3452 LAKE LYNDA DR STE 200",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328171481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3452 LAKE LYNDA DR STE 200",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328171481",
"telephone_number": "800-774-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "JUSTIN",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-13",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "8726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.