Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 608 | NC |
NPI | 1003092230 |
---|---|
Provider Name | Peggy Steele Womble |
First Address | Sanford, NC 27330-2468 |
Second Address | Sanford, NC 27330-2468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 17/01/2008 |