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NPI Code Detail

MEDICARE: COLLEEN PETERSON MPT

MEDICARE: COLLEEN PETERSON MPT
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
1225100000XPhysical TherapistPT003064EPA

General Provider Information

NPI Number : 1851418248
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN PETERSON MPT
Provider Business Mailing Address
First Line : 1218 MELODY LN
Second Line :
City : SOUTHAMPTON
State : PA
Zip : 18966-4320
Country : US
Telephone Number : 215-364-5102
Fax Number :
Provider Business Practice Location Address
First Line : 8015 LAWNDALE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-1507
Country : US
Telephone Number : 215-725-2525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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