Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1134138415 |
---|---|
Provider Name | Mrs. Amy Michele Peck |
First Address | Phoenix, AZ 85048-0533 |
Second Address | Phoenix, AZ 85012-1839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |