MEDICARE: JULIE ANNE PETERSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1679198089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANNE PETERSEN

Provider Business Mailing Address
First Line	:	7505 VILLAGE SQUARE DR
Second Line	:
City	:	CASTLE PINES
State	:	CO
Zip	:	80108-3692
Country	:	US
Telephone Number	:	303-805-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 VILLAGE SQUARE DR
Second Line	:
City	:	CASTLE PINES
State	:	CO
Zip	:	80108-3692
Country	:	US
Telephone Number	:	303-805-5156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/11/2020

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Directions to “ JULIE ANNE PETERSEN ” Practice Location

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