Provider Demographics
NPI:1457803405
Name:BRISBANE, PEGGY (LMT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BRISBANE
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 1:77-361 MELE PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9726
Mailing Address - Country:US
Mailing Address - Phone:907-942-2451
Mailing Address - Fax:
Practice Address - Street 1:75-5870 WALUA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1392
Practice Address - Country:US
Practice Address - Phone:808-329-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist