Provider Demographics
NPI:1821106253
Name:TAYLOR, PEGGY JANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:JANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11503 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3460
Mailing Address - Country:US
Mailing Address - Phone:206-439-6838
Mailing Address - Fax:206-439-0574
Practice Address - Street 1:16259 SYLVESTER RD SW STE 102
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3094
Practice Address - Country:US
Practice Address - Phone:206-242-5186
Practice Address - Fax:206-241-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist