Provider Demographics
NPI:1265624464
Name:PECK, ELIZABETH JOANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JOANN
Last Name:PECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:JOANN
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10300 NE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3831
Mailing Address - Country:US
Mailing Address - Phone:503-257-5500
Mailing Address - Fax:
Practice Address - Street 1:10300 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3831
Practice Address - Country:US
Practice Address - Phone:503-257-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist