Healthcare Provider Details

I. General information

NPI: 1154426625
Provider Name (Legal Business Name): KATHRYN C PECKHAM DPT, CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN CARTER MOESER PECKHAM PT, DPT, CMP

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 E WEST RD
MIDLOTHIAN VA
23114-3372
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4064
  • Fax: 804-320-4052
Mailing address:
  • Phone: 804-915-1910
  • Fax: 804-968-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: