Provider Demographics
NPI:1770073363
Name:WITHERS, PEGGIE
Entity type:Individual
Prefix:
First Name:PEGGIE
Middle Name:
Last Name:WITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 E R AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS
Mailing Address - State:MI
Mailing Address - Zip Code:49088
Mailing Address - Country:US
Mailing Address - Phone:269-275-3076
Mailing Address - Fax:
Practice Address - Street 1:14221 E R AVE
Practice Address - Street 2:
Practice Address - City:SCOTTS
Practice Address - State:MI
Practice Address - Zip Code:49088
Practice Address - Country:US
Practice Address - Phone:269-275-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant