Provider Demographics
NPI:1659616720
Name:PEASE, VICKY LYN (PT)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYN
Last Name:PEASE
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 1:51 LINDA CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2666
Mailing Address - Country:US
Mailing Address - Phone:925-287-9213
Mailing Address - Fax:
Practice Address - Street 1:9000 E NICHOLS AVE STE 201
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3406
Practice Address - Country:US
Practice Address - Phone:925-209-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist