Provider Demographics
NPI:1326102070
Name:OSBORNE, PEGGY R (LMT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:R
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 EAST 43RD STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1827
Mailing Address - Country:US
Mailing Address - Phone:360-936-3597
Mailing Address - Fax:
Practice Address - Street 1:3303 NE 44TH STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1827
Practice Address - Country:US
Practice Address - Phone:360-936-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist