Provider Demographics
NPI:1255392296
Name:PEAVY, JASON B (ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:B
Last Name:PEAVY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CLOVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-4239
Mailing Address - Country:US
Mailing Address - Phone:334-382-6600
Mailing Address - Fax:334-382-9484
Practice Address - Street 1:100 ADAMS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2602
Practice Address - Country:US
Practice Address - Phone:334-382-5308
Practice Address - Fax:334-382-9484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer