Active NPI
Nola Peacock, PT, DSC
- Physical Therapist
- Jackson, WY
National Provider Identifier
1447785829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-0665
- Practice address
- 555 E Broadway Ave
Suite 113
Jackson, WY 83001-8640 - Phone
- (307) 739-7628
- NPI assigned
- Apr 24, 2017
- Sex
- Female
- 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 | PT-0665 | WY | Primary |
Addresses
Primary practice location
555 E Broadway Ave
Suite 113
Jackson, WY 83001-8640
Mailing address
PO Box 11124
Jackson, WY 83002-1124
Phone (307) 739-7628
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-0665 | WY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492992000000",
"number": "1447785829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11124",
"city": "JACKSON",
"state": "WY",
"postal_code": "830021124",
"telephone_number": "307-739-7628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 E BROADWAY AVE",
"address_2": "SUITE 113",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018640",
"telephone_number": "307-739-7628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "NOLA",
"name_prefix": "Dr.",
"credential": "PT, DSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-24",
"last_updated": "2017-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WY",
"license": "PT-0665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.