Provider Demographics
NPI:1295859049
Name:HALWACHS, PEGGY A (PT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:HALWACHS
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 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3900
Mailing Address - Fax:425-673-3910
Practice Address - Street 1:190 W DAYTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4182
Practice Address - Country:US
Practice Address - Phone:425-582-8118
Practice Address - Fax:425-582-7420
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000031792251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA363574OtherWA LABOR & INDUSTRIES
WA2088291Medicaid