Provider Demographics
NPI:1184758294
Name:PESHKE, NANCY ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:PESHKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SARINA TER SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4042
Mailing Address - Country:US
Mailing Address - Phone:772-794-0176
Mailing Address - Fax:772-794-1621
Practice Address - Street 1:545 SARINA TER SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4042
Practice Address - Country:US
Practice Address - Phone:772-794-0176
Practice Address - Fax:772-794-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant