Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06004511A | IN |
NPI | 1003352287 |
---|---|
Provider Name | David Peachey |
First Address | Elkhart, IN 46514-4372 |
Second Address | Elkhart, IN 46514-4372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2017 |
Last Update Date | 12/01/2017 |