Provider Demographics
NPI:1144335860
Name:PEPPLEY, ANTHONY TODD (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TODD
Last Name:PEPPLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:457 S FITNESS PL
Mailing Address - Street 2:STE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6568
Mailing Address - Country:US
Mailing Address - Phone:208-939-3332
Mailing Address - Fax:208-939-3338
Practice Address - Street 1:457 S FITNESS PL
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6568
Practice Address - Country:US
Practice Address - Phone:208-939-3332
Practice Address - Fax:208-939-3338
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPT-1520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010028601OtherBLUE SHIELD
IDT4363OtherTRUE BLUE
ID806054500Medicaid
ID11347663OtherFIRST HEALTH NETWORK
IDT4363OtherBLUE CROSS
IDP00165209OtherSTATE OF WA DEPT OF LABOR
IDP00165209OtherSTATE OF WA DEPT OF LABOR