Healthcare Provider Details

I. General information

NPI: 1447655519
Provider Name (Legal Business Name): PEGGY MANGAN MS REHABILITATION CO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E COTTONWOOD LN
CASA GRANDE AZ
85122-2500
US

IV. Provider business mailing address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5502
US

V. Phone/Fax

Practice location:
  • Phone: 833-431-4449
  • Fax: 520-876-1796
Mailing address:
  • Phone: 833-431-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72506
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC24296
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: