Healthcare Provider Details

I. General information

NPI: 1689579740
Provider Name (Legal Business Name): PEGGY PAPENHAGEN PT, DPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 PALMYRA RD
PALMYRA MI
49268-9799
US

IV. Provider business mailing address

5765 PALMYRA RD
PALMYRA MI
49268-9799
US

V. Phone/Fax

Practice location:
  • Phone: 517-206-4597
  • Fax:
Mailing address:
  • Phone: 517-206-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009920
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06861
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: