Provider Demographics
NPI:1154426625
Name:MOESER-PECKHAM, KATHRYN CARTER (DPT, CMP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CARTER
Last Name:MOESER-PECKHAM
Suffix:
Gender:F
Credentials:DPT, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6202
Mailing Address - Country:US
Mailing Address - Phone:253-761-7795
Mailing Address - Fax:253-761-7796
Practice Address - Street 1:3007 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-6202
Practice Address - Country:US
Practice Address - Phone:253-761-7795
Practice Address - Fax:253-761-7796
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT8647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA174185OtherLABOR & INDUSTRIES
WA8373581Medicaid