Most Relevant Information
Provider Data
| NPI Number: | 1003393430 |
| Provider Name: | NICHOLAS PEYTON ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 092014 |
Most Important Dates
| Enumeration Date: | 07/27/2018 |
| Last Updated: | 12/31/2019 |
Provider Practice Location
6000 N ALLEN RD
PEORIA
IL
616143294
Practice Location Phone/Fax
| Phone: | 3096897044 |
| Fax: | 3096897094 |
Provider Mailing Location
6000 N ALLEN RD
PEORIA
IL
616143294
Provider Mailing Phone/Fax
| Phone: | 3096911400 |
| Fax: | 3096897094 |