Healthcare Provider Details

I. General information

NPI: 1013990092
Provider Name (Legal Business Name): PEGGY HANIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 SE RASMUSSEN BLVD STE 115
BATTLE GROUND WA
98604-8618
US

IV. Provider business mailing address

13512 NE 238TH WAY
BATTLE GROUND WA
98604-4792
US

V. Phone/Fax

Practice location:
  • Phone: 360-702-6494
  • Fax: 360-984-5845
Mailing address:
  • Phone: 360-702-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: