Active NPI
Jacob Peck
- Physical Therapy Assistant
- Wasilla, AK
National Provider Identifier
1659120483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TE013514
- Practice address
- 6701 W Blondell Drive
Wasilla, AK 99623 - Phone
- (907) 357-9755
- NPI assigned
- May 14, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA.0015525 | CO | |
| Physical Therapy Assistant | 225200000X | 231916 | AK | |
| Physical Therapy Assistant | 225200000X | TE013514 | PA | Primary |
Addresses
Primary practice location
6701 W Blondell Drive
Wasilla, AK 99623
Mailing address
5649 Meshoppen Creek Rd
Montrose, PA 18801-7658
Phone (607) 651-6564
Other practice location 1
554 Hamlin Hwy Unit 2
Lake Ariel, PA 18436-9319
Phone (570) 218-5405
Other practice location 2
3455 Rewak Dr Ste 106
Fairbanks, AK 99709-5024
Phone (907) 457-5322
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 |
|---|---|---|---|
| 231916 | AK | MD | Physical Therapy Assistant |
| PTA.0015525 | CO | MD | Physical Therapy Assistant |
| TE013514 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736467200000",
"number": "1659120483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5649 MESHOPPEN CREEK RD",
"city": "MONTROSE",
"state": "PA",
"postal_code": "188017658",
"telephone_number": "607-651-6564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6701 W BLONDELL DRIVE",
"city": "WASILLA",
"state": "AK",
"postal_code": "99623",
"telephone_number": "907-357-9755"
}
],
"practiceLocations": [
{
"address_1": "554 Hamlin Hwy Unit 2",
"address_purpose": "LOCATION",
"city": "Lake Ariel",
"state": "PA",
"postal_code": "184369319",
"country_code": "US",
"telephone_number": "570-218-5405",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3455 Rewak Dr Ste 106",
"address_purpose": "LOCATION",
"city": "Fairbanks",
"state": "AK",
"postal_code": "997095024",
"country_code": "US",
"telephone_number": "907-457-5322",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PECK",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-14",
"last_updated": "2025-01-10",
"certification_date": "2025-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "PTA.0015525",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AK",
"license": "231916",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TE013514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.