Provider Demographics
NPI:1306323514
Name:GOLEMBECK, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:GOLEMBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 ALDEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4824
Mailing Address - Country:US
Mailing Address - Phone:763-913-4204
Mailing Address - Fax:
Practice Address - Street 1:6211 ALDEN WAY NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4824
Practice Address - Country:US
Practice Address - Phone:763-913-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1031208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation