Amy Joan Peckens, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502000855 Issued in MI

Practice address

1215 E Michigan Ave
Lansing, MI 48912-1811

Phone

(517) 253-2436

NPI assigned

Dec 26, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1545782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545782400000",
    "number": "1295207652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8407 KINLEY RD",
            "city": "OVID",
            "state": "MI",
            "postal_code": "488669674",
            "telephone_number": "989-307-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-253-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECKENS",
        "first_name": "AMY",
        "middle_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-26",
        "last_updated": "2018-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502000855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5502000855",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pearle Vision Inc
• Pearle Vision Inc
• Jennifer Pearson
• Randolph Lester Pearson, M.D.
• Kellie Sue Peck, DPT
• Nikole G Pecora, DDS MS
• Pediatric Care of Lansing PC
• Pediatric Physicians of Lansing
• Isaac Nicholas Peeters, LLPC
• Elizabeth Margery Pelletier, PAC

• Physical Therapy Assistant in Lansing, MI
• Providers in Lansing, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2018; 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.