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General NPI Number Information
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NPI Number | 1689842809
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Entity Type | Individual
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Provider Name | PEGGY RICHARDS LMT
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Gender | Female
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 299 W BRONX RD UNIT A
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City | SANDPOINT
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State | ID
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Zip | 83864-9505
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Country | US
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Telephone | 208-263-7270
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Fax |
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Provider Business Mailing Address
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Address Line | 217 CEDAR ST # 271
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City | SANDPOINT
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State | ID
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Zip | 83864-1410
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Country | US
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Telephone | 208-263-7270
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MT-04668P
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License Number State | AZ
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