Provider Demographics
NPI:1164976247
Name:WEBB, PEGGY JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JEAN
Last Name:WEBB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N PINE ST
Mailing Address - Street 2:#2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1865
Mailing Address - Country:US
Mailing Address - Phone:907-717-2522
Mailing Address - Fax:
Practice Address - Street 1:401 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2814
Practice Address - Country:US
Practice Address - Phone:907-770-6325
Practice Address - Fax:907-770-6586
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101433225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist