Provider Demographics
NPI:1922248590
Name:RISCH, PEGGY RENE (RPT)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:RENE
Last Name:RISCH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:RENE
Other - Last Name:RISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2761
Mailing Address - Country:US
Mailing Address - Phone:530-261-1344
Mailing Address - Fax:
Practice Address - Street 1:206 ROELOFS CT
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2761
Practice Address - Country:US
Practice Address - Phone:530-261-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist