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General NPI Number Information
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NPI Number | 1851874572
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Entity Type | Individual
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Provider Name | PEGGY ANN FORSYTHE PTA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 09/09/2018
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Provider Practice Location Address
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Address Line | 1009 CLYDE ST
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City | AMARILLO
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State | TX
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Zip | 79106-4225
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Country | US
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Telephone | 806-352-5295
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Fax |
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Provider Business Mailing Address
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Address Line | 7406 ALEXANDRIA AVE
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City | AMARILLO
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State | TX
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Zip | 79118-6251
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT034133
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2013561
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License Number State | TX
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