Provider Demographics
NPI:1255647293
Name:SNOW, PEGGY SUE (LMP)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:SUE
Last Name:SNOW
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208NESTATE HIGHWAY 104
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346
Mailing Address - Country:US
Mailing Address - Phone:360-297-0420
Mailing Address - Fax:
Practice Address - Street 1:8202 NE STATE HIGHWAY 104 STE 105
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-297-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60141827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist