Forrest Q Pecha, MS, ATC, LAT, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001169 Issued in GA

Practice address

1109 W Myrtle St
Suite 200
Boise, ID 83702-6970

Phone

(208) 489-4331

NPI assigned

Jun 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1639372709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12664 N 13TH AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837145061",
            "telephone_number": "208-908-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 W MYRTLE ST",
            "address_2": "SUITE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026970",
            "telephone_number": "208-489-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECHA",
        "first_name": "FORREST",
        "middle_name": "Q",
        "credential": "MS, ATC, LAT, OTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001169",
            "primary": true
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "GA",
            "license": "02 5855",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-391",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tomi Pearson
• Pease Family Chiropractic P.C. (Pease Family Chiropractic)
• Jeffrey Bryan Pease, D.C.
• Kelli M Pease, PA
• Shaylan Pease, PA-C
• Diane Peck-Niznik, OTR/L
• Dallas D Peck, M.D.
• Matthew Anthony Peck, LPC
• Robert T Peck, DMD
• Theresa Michele Pecsek, PMHNP-BC

• Athletic Trainer in Boise, ID
• Providers in Boise, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.