Basic Information
| Provider Information | |||||||||
| NPI: | 1821106253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11503 29TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981463460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064396838 | ||||||||
| FaxNumber: | 2064390574 | ||||||||
| Practice Location | |||||||||
| Address1: | 16259 SYLVESTER RD SW STE 102 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062425186 | ||||||||
| FaxNumber: | 2062418467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA00014466 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.