Provider Demographics
NPI:1255573051
Name:HICE, PEGGY SUE (LMT)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:HICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-8836
Mailing Address - Country:US
Mailing Address - Phone:817-454-3570
Mailing Address - Fax:817-444-5700
Practice Address - Street 1:176 CEDAR DR
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-8836
Practice Address - Country:US
Practice Address - Phone:817-454-3570
Practice Address - Fax:817-444-5700
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT033884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist