Individual
DR. NOLA PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DSC
Contact information
Practice address
555 E BROADWAY AVE, SUITE 113, JACKSON, WY 83001-8640
(307) 739-7628
Mailing address
PO BOX 11124, JACKSON, WY 83002-1124
(307) 739-7628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-0665
WY
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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