Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT005740 | GA |
NPI | 1043371974 |
---|---|
Provider Name | Peggy Teague |
First Address | Lawrenceville, GA 30044-4608 |
Second Address | Lawrenceville, GA 30043-7986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 27/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000765817A | (05) | GA |
10037766 | (05) | GA |
306072 | (05) | GA |