Provider Demographics
NPI:1811182413
Name:PETERS, BEVERLY ANN (LMP)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1675
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-1675
Mailing Address - Country:US
Mailing Address - Phone:509-687-3278
Mailing Address - Fax:509-682-4079
Practice Address - Street 1:130 EAST CHELAN AVENUE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-3000
Practice Address - Country:US
Practice Address - Phone:509-687-3278
Practice Address - Fax:509-682-4079
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0078218OtherDEPARTMENT OF L&I