Provider Demographics
NPI:1275674160
Name:STELL, PEGGY (PT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:STELL
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 1:38W497 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6028
Mailing Address - Country:US
Mailing Address - Phone:630-584-6548
Mailing Address - Fax:
Practice Address - Street 1:38W497 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6028
Practice Address - Country:US
Practice Address - Phone:630-584-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist