Provider Demographics
NPI:1972306553
Name:PECK, JAMES ELLIOTT (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ELLIOTT
Last Name:PECK
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5934
Mailing Address - Country:US
Mailing Address - Phone:865-978-0056
Mailing Address - Fax:
Practice Address - Street 1:55 W LAKE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:TN
Practice Address - Zip Code:38578-3002
Practice Address - Country:US
Practice Address - Phone:931-200-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8447225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant