Provider Demographics
NPI:1326931189
Name:PEEBLES, RICHARD III
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PEEBLES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 MOSS GATE TER
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1672
Mailing Address - Country:US
Mailing Address - Phone:804-426-1113
Mailing Address - Fax:
Practice Address - Street 1:4243 LLEWELLYN AVE APT 203
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1133
Practice Address - Country:US
Practice Address - Phone:804-426-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer