Healthcare Provider Details

I. General information

NPI: 1114129087
Provider Name (Legal Business Name): PEGGY L HARROP PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W NORTH BLVD SUITE D
LEESBURG FL
34748-5063
US

IV. Provider business mailing address

1824 ENGLEWOOD ST
LADY LAKE FL
32162-7666
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-9300
  • Fax:
Mailing address:
  • Phone: 352-751-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA15523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: