Provider Demographics
NPI:1114344082
Name:SYMMANK, PEGGY
Entity Type:Individual
Prefix:MISS
First Name:PEGGY
Middle Name:
Last Name:SYMMANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27401 TIMBER CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3012
Mailing Address - Country:US
Mailing Address - Phone:713-806-7929
Mailing Address - Fax:
Practice Address - Street 1:19285 DAVID MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8778
Practice Address - Country:US
Practice Address - Phone:281-419-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012183225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant