Provider Demographics
NPI:1609095074
Name:CONLEY, PEGGY LOU (LMP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LOU
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:L
Other - Last Name:BAIJOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16518 80TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9192
Mailing Address - Country:US
Mailing Address - Phone:425-775-2288
Mailing Address - Fax:425-778-5476
Practice Address - Street 1:6501 196TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5980
Practice Address - Country:US
Practice Address - Phone:425-775-2288
Practice Address - Fax:425-778-5476
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist