Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT523 | ME |
NPI | 1093835589 |
---|---|
Provider Name | Ms. Peggy Scales Packett |
First Address | Harpswell, ME 04079-4252 |
Second Address | Harpswell, ME 04079-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030977 | ANTHEM (01) | ME |