Basic Information
| Provider Information | |||||||||
| NPI: | 1295859049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALWACHS | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7320 216TH ST SW STE 320 | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256733900 | ||||||||
| FaxNumber: | 4256733910 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 W DAYTON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980204182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255828118 | ||||||||
| FaxNumber: | 4255827420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | PT00003179 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | PT00003179 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | PT00003179 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 363574 | 01 | WA | WA LABOR & INDUSTRIES | OTHER | 2088291 | 05 | WA | MEDICAID |