Peckham Enterprises, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

8647 Issued in WA

Legal business name

PECKHAM ENTERPRISES, LLC

Doing business as

North End Physical Therapy

Practice address

3007 6TH Ave
Tacoma, WA 98406-6202

Phone

(253) 761-7795

Fax

(253) 761-7796

NPI assigned

Nov 6, 2009

Last updated

Jul 11, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathryn Carter Moeser-Peckham, DPT, CMP

Title

Owner

Phone

(253) 761-7795

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NORTH END PHYSICAL THERAPY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341964800000",
    "number": "1205163524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3007 6TH AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984066202",
            "telephone_number": "253-761-7795",
            "fax_number": "253-761-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 6TH AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984066202",
            "telephone_number": "253-761-7795",
            "fax_number": "253-761-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECKHAM ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2012-07-11",
        "status": "A",
        "authorized_official_last_name": "MOESER-PECKHAM",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "CARTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-761-7795",
        "authorized_official_credential": "DPT, CMP"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "8647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8373581",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTH END PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Pearson, BA
• Lilah Pearson, L.M.P.
• Nathaniel G Pearson, M.A.
• Laura Dorothea Pebley
• Jason William Peck, MSW
• Ferowsi Pecoraro
• James Daniel Pecsok, MD
• Ashley Pedde
• Chris John Pederson
• Jonathan Pederson, DO

• Physical Therapy Clinic/Center in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Physical Therapy Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.