Healthcare Provider Details

I. General information

NPI: 1235589672
Provider Name (Legal Business Name): KATIE PETERSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188B N MERIDIAN ST STE 230
CARMEL IN
46032-4939
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-705-4640
  • Fax: 317-705-4649
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: