Healthcare Provider Details

I. General information

NPI: 1568617249
Provider Name (Legal Business Name): PETERSON PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2008
Last Update Date: 11/23/2008
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

7205 W CENTER RD #101
OMAHA NE
68124-2380
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2020
License Number StateNE

VIII. Authorized Official

Name: DR. JULIE ANNE PETERSON
Title or Position: PRESIDENT
Credential: D.P.T.
Phone: 402-390-1027