Provider Demographics
NPI:1285845461
Name:PEITCHINSKY, DESIREE (PT)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:PEITCHINSKY
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 1:155 HIDDEN OAKS LOOP
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5562
Mailing Address - Country:US
Mailing Address - Phone:512-925-5007
Mailing Address - Fax:
Practice Address - Street 1:219B S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2941
Practice Address - Country:US
Practice Address - Phone:512-925-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129971261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy