Individual
MARK PECKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2296 COUNTRY DR, FREMONT, CA 94536-5315
(510) 608-3733
Mailing address
2296 COUNTRY DR, FREMONT, CA 94536-5315
(510) 608-3733
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2445
CA
Other
Enumeration date
04/15/2009
Last updated
04/15/2009
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