Provider Demographics
NPI:1780640045
Name:LANGLEY, PEGGY LEE (PT, CHT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20118 N 67TH AVE
Mailing Address - Street 2:#300-465
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4621
Mailing Address - Country:US
Mailing Address - Phone:623-979-2747
Mailing Address - Fax:623-979-3122
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:BLDG #100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:623-979-2747
Practice Address - Fax:623-979-3122
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12942251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ81210OtherMEDICARE
AZ852790OtherACCHS