Healthcare Provider Details

I. General information

NPI: 1356451561
Provider Name (Legal Business Name): JULIE ANNE PETERSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 W CENTER RD 101
OMAHA NE
68124-2380
US

IV. Provider business mailing address

5112 NICHOLAS ST
OMAHA NE
68132-1434
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-1027
  • Fax: 402-390-1037
Mailing address:
  • Phone: 402-498-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: