Provider Demographics
NPI:1841077054
Name:MCMAHAN, PEGGY SUE
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUE
Last Name:MCMAHAN
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 1:1322 FLORIDA RD APT 4
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6207
Mailing Address - Country:US
Mailing Address - Phone:970-946-3540
Mailing Address - Fax:
Practice Address - Street 1:3600 MAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4082
Practice Address - Country:US
Practice Address - Phone:970-259-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0007795225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist