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General NPI Number Information
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NPI Number | 1104908540
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Entity Type | Individual
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Provider Name | SUSAN PETERSON PT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | 134 DRURY DR
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City | LA PLATA
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State | MD
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Zip | 20646-4241
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Country | US
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Telephone | 301-539-3807
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Fax | 301-539-3814
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | LA PLATA
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State | MD
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Zip | 20646-0102
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Country | US
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Telephone | 301-539-3807
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Fax | 301-539-3814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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