Provider Demographics
NPI:1073879805
Name:ELLIOTT, PEGGY L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2732 CAPITAL CIR NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4108
Mailing Address - Country:US
Mailing Address - Phone:850-671-2313
Mailing Address - Fax:850-385-9383
Practice Address - Street 1:2732 CAPITAL CIR NE
Practice Address - Street 2:SUITE 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4108
Practice Address - Country:US
Practice Address - Phone:850-671-2313
Practice Address - Fax:850-385-9383
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA9707172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist