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NPI Code Detail

MEDICARE: MRS. PEGGY J NEVILLE PTA

MEDICARE: MRS. PEGGY J NEVILLE PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant06001517AIN

General Provider Information

NPI Number : 1710184205
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PEGGY J NEVILLE PTA
Provider Business Mailing Address
First Line : 781 TATEAM DR
Second Line :
City : DANVILLE
State : IN
Zip : 46122-9384
Country : US
Telephone Number : 317-745-1946
Fax Number :
Provider Business Practice Location Address
First Line : 255 MEADOW DR
Second Line :
City : DANVILLE
State : IN
Zip : 46122-1415
Country : US
Telephone Number : 317-745-5451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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