Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3657 | AZ |
NPI | 1114168838 |
---|---|
Provider Name | Jennifer L. Peery |
First Address | Peoria, AZ 85383-2404 |
Second Address | Peoria, AZ 85383-2404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2009 |
Last Update Date | 09/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400432 | AHCCCS (01) | AZ |