Provider Demographics
NPI:1710221049
Name:PEDEN, DARLENE ANNE (LPTA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:ANNE
Last Name:PEDEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COUNTY ROAD 272
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-4957
Mailing Address - Country:US
Mailing Address - Phone:256-718-0005
Mailing Address - Fax:
Practice Address - Street 1:813 KELLER LN
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1110
Practice Address - Country:US
Practice Address - Phone:256-383-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA1130225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant