Provider Demographics
NPI:1326188699
Name:WILSON, PEGGY E (PT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:E
Last Name:WILSON
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 1:120 E GEORGE HOPPER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3125
Mailing Address - Country:US
Mailing Address - Phone:360-757-9335
Mailing Address - Fax:360-757-9886
Practice Address - Street 1:120 E GEORGE HOPPER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3125
Practice Address - Country:US
Practice Address - Phone:360-757-9335
Practice Address - Fax:360-757-9886
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5582WIOtherREGENCE
WA5582WIOtherPREMERA BLUE CROSS
WA0168030OtherLABOR & INDUSTRIES
WAGAB36677Medicare ID - Type Unspecified