Healthcare Provider Details

I. General information

NPI: 1104273788
Provider Name (Legal Business Name): PEGGY NORMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR SUITE 200
COLORADO SPRINGS CO
80920-7502
US

IV. Provider business mailing address

194 CEDAR AVE
CASTLE ROCK CO
80104-2230
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 720-373-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13836
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: