Healthcare Provider Details

I. General information

NPI: 1285845461
Provider Name (Legal Business Name): DESIREE PEITCHINSKY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219B S MAIN ST
ELGIN TX
78621-2941
US

IV. Provider business mailing address

155 HIDDEN OAKS LOOP P.O. BOX 369
ELGIN TX
78621-5562
US

V. Phone/Fax

Practice location:
  • Phone: 512-925-5007
  • Fax:
Mailing address:
  • Phone: 512-925-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1129971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: