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General NPI Number Information
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NPI Number | 1679872246
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Entity Type | Individual
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Provider Name | CATHY GAYLYNN PEGUES
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Gender | Female
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 6801 W POLY WEBB RD
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City | ARLINGTON
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State | TX
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Zip | 76016-3640
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Country | US
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Telephone | 757-748-9903
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 CRESTVIEW DR
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City | CLEBURNE
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State | TX
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Zip | 76033-6017
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Country | US
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Telephone | 817-975-2287
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2063107
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License Number State | TX
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