Provider Demographics
NPI:1053755835
Name:WASSER SCOTT, PEGGY JO (PT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:WASSER SCOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2200
Mailing Address - Fax:515-241-2201
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2200
Practice Address - Fax:515-241-2201
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01953225100000X, 226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1053755835Medicaid
IA719260586Medicare PIN