Individual
JOHN EDWARD PECKENPAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2901 174TH ST NE, MARYSVILLE, WA 98271-4743
(360) 454-1945
(360) 339-4219
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(206) 860-5414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5558
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235201880
—
WA
05
—
7083330
—
WA
01
—
P01310153
MEDICARE RR
WA
Enumeration date
11/15/2006
Last updated
02/02/2026
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