Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 01953 | IA |
N | 226300000X | Kinesiotherapist | 01953 | IA |
NPI | 1053755835 |
---|---|
Provider Name | Peggy Jo Wasser Scott |
First Address | West Des Moines, IA 50266-8203 |
Second Address | West Des Moines, IA 50266-8203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053755835 | (05) | IA |