Individual
KELLY PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1835 S SEPULVEDA BLVD, LOS ANGELES, CA 90025-4313
(310) 478-6222
(310) 478-6696
Mailing address
27023 TIMBERLINE TER, VALENCIA, CA 91381-0623
(213) 309-5767
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT22097
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT22097
CA PHYSICAL THERAPY LICENSE
CA
Enumeration date
04/02/2009
Last updated
04/02/2009
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