Organization
REJUVENATION MEDSPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MICHAEL PEASAK DO (OWNER/PROVIDER)
(304) 841-1293
Entity
Organization
Contact information
Practice address
1400 JOHNSON AVE STE 4A, BRIDGEPORT, WV 26330-1063
(304) 848-9998
(304) 848-9996
Mailing address
1400 JOHNSON AVE STE 4A, BRIDGEPORT, WV 26330-1063
(304) 848-9998
(304) 848-9996
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942
WV LICENSE NUMBER
WV
Enumeration date
01/17/2019
Last updated
01/17/2019
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