NPIMap

Organization Active NPI

Peacock Physical Therapy Services LLC

  • Physical Therapist
  • Waldorf, MD
National Provider Identifier
1881934453
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PEACOCK PHYSICAL THERAPY SERVICES LLC
Practice address
11813 Park Waldorf LN Ste 522
Waldorf, MD 20601
Phone
(240) 718-8103
NPI assigned
Feb 19, 2013
Last updated
Jun 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Authorized official

Name
Dr. Janine Peacock, PTNPI 1891959334
Title
Owner
Phone
(240) 718-8103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

11813 Park Waldorf LN Ste 522
Waldorf, MD 20601

Mailing address

PO Box 1066
Waldorf, MD 20604-1066
Phone (240) 718-8103

National Provider Directory

National Provider Directory

Locations

11813 Park Waldorf Ln
Ste 522
Waldorf, MD 20601
Phone (240) 718-8103

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1881934453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1066",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206041066",
            "telephone_number": "240-718-8103",
            "fax_number": "443-729-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11813 PARK WALDORF LN STE 522",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "20601",
            "telephone_number": "240-718-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK PHYSICAL THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "PEACOCK",
        "authorized_official_first_name": "JANINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-718-8103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.