Healthcare Provider Details

I. General information

NPI: 1053540765
Provider Name (Legal Business Name): PEGGY BLACKMAN P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 ST CLAIRE BLVD BLDG A #2
MISSION TX
78572-6636
US

IV. Provider business mailing address

500 LINDBERG AVE
MCALLEN TX
78501-2924
US

V. Phone/Fax

Practice location:
  • Phone: 956-584-3535
  • Fax: 956-584-3633
Mailing address:
  • Phone: 956-687-4560
  • Fax: 956-618-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2013454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: