Provider Demographics
NPI:1235576950
Name:PEAVLER, ANNA C (PT DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:C
Last Name:PEAVLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:SIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:1 UNIVERSITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-829-3411
Mailing Address - Fax:340-715-4678
Practice Address - Street 1:1 UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-829-3411
Practice Address - Fax:904-829-3411
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4549225100000X
FL31954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist