Provider Demographics
NPI:1548251812
Name:BASSFORD, PEGGY FORD (LRTT)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:FORD
Last Name:BASSFORD
Suffix:
Gender:F
Credentials:LRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2810
Mailing Address - Country:US
Mailing Address - Phone:318-798-7643
Mailing Address - Fax:
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6327
Practice Address - Fax:318-456-6814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACRT.LT04462278P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics