Provider Demographics
NPI:1679872246
Name:PEGUES, CATHY GAYLYNN
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:GAYLYNN
Last Name:PEGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-6017
Mailing Address - Country:US
Mailing Address - Phone:817-975-2287
Mailing Address - Fax:
Practice Address - Street 1:6801 W POLY WEBB RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3640
Practice Address - Country:US
Practice Address - Phone:757-748-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2063107225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant