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General NPI Number Information
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NPI Number | 1457803405
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Entity Type | Individual
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Provider Name | PEGGY BRISBANE LMT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 75-5870 WALUA RD SUITE 101
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City | KAILUA KONA
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State | HI
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Zip | 96740-1392
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Country | US
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Telephone | 808-329-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 77-361 MELE PL
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City | KAILUA KONA
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State | HI
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Zip | 96740-9726
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Country | US
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Telephone | 907-942-2451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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