Individual
JACOB PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6701 W BLONDELL DRIVE, WASILLA, AK 99623
(907) 357-9755
Mailing address
5649 MESHOPPEN CREEK RD, MONTROSE, PA 18801-7658
(607) 651-6564
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
231916
AK
225200000X
Physical Therapy Assistant
PTA.0015525
CO
225200000X
Physical Therapy Assistant
Primary
TE013514
PA
Other
Enumeration date
05/14/2024
Last updated
01/10/2025
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