Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00003179 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00003179 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00003179 | WA |
NPI | 1295859049 |
---|---|
Provider Name | Peggy A Halwachs |
First Address | Edmonds, WA 98026-8006 |
Second Address | Edmonds, WA 98020-4182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2088291 | (05) | WA |
363574 | WA LABOR & INDUSTRIES (01) | WA |
S87979 | (02) | WA |