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General NPI Number Information
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NPI Number | 1205163524
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Entity Type | Organization
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Legal Business Name | PECKHAM ENTERPRISES, LLC
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 3007 6TH AVE
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City | TACOMA
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State | WA
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Zip | 98406-6202
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Country | US
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Telephone | 253-761-7795
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Fax | 253-761-7796
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Provider Business Mailing Address
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Address Line | 3007 6TH AVE
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City | TACOMA
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State | WA
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Zip | 98406-6202
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Country | US
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Telephone | 253-761-7795
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Fax | 253-761-7796
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN CARTER MOESER-PECKHAM
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Credential | DPT, CMP
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Telephone | 253-761-7795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 8647
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License Number State | WA
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