Healthcare Provider Details

I. General information

NPI: 1225542947
Provider Name (Legal Business Name): ALEXANDRIA PETERSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY AVE STE 185
SACRAMENTO CA
95825-6739
US

IV. Provider business mailing address

601 UNIVERSITY AVE STE 185
SACRAMENTO CA
95825-6739
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1333
  • Fax:
Mailing address:
  • Phone: 916-927-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: