Provider Demographics
NPI:1053607382
Name:MCPETERS, NANCY JANE (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:MCPETERS
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 1:16935 FORREST ST
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1326
Mailing Address - Country:US
Mailing Address - Phone:661-298-7943
Mailing Address - Fax:
Practice Address - Street 1:16935 FORREST ST
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-1326
Practice Address - Country:US
Practice Address - Phone:661-298-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist