Doctor Name: | PEGGY A IVAN |
NPI Number: | 1013963206 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 406631-00 |
Business Practice Address: | 3680 S Orr Rd Freeland, MI - 486239111 |
Business Phone Number: | 9896959282 |
Business Fax Number: | 9896959283 |
Mailing Address: | 3680 S Orr Rd, FREELAND |
State: | MI |
Postal Code: | 486239111 |
Phone Number: | 9896959282 |
Fax Number: | 9896959283 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 02/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 406631-00 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |