Provider Demographics
NPI:1093835589
Name:PACKETT, PEGGY SCALES (PT)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SCALES
Last Name:PACKETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HIDDEN POND RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-4252
Mailing Address - Country:US
Mailing Address - Phone:207-721-9117
Mailing Address - Fax:
Practice Address - Street 1:55 HIDDEN POND RD
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-4252
Practice Address - Country:US
Practice Address - Phone:207-721-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME030977OtherANTHEM