Provider Demographics
NPI:1982597035
Name:PEACH, PATRICK (ATC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PEACH
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 1:2884 MAIDENS RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-4819
Mailing Address - Country:US
Mailing Address - Phone:804-584-9339
Mailing Address - Fax:
Practice Address - Street 1:2884 MAIDENS RD
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-4819
Practice Address - Country:US
Practice Address - Phone:804-584-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer