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General NPI Number Information
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NPI Number | 1174147094
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Entity Type | Individual
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Provider Name | DANIELLE SPENCER PETERSEN DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 11680 HIGHWAY 51 S STE A-1
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City | ATOKA
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State | TN
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Zip | 38004-7604
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Country | US
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Telephone | 901-837-0994
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Fax | 901-837-0999
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Provider Business Mailing Address
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Address Line | 6600 STAGE RD STE 129
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City | BARTLETT
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State | TN
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Zip | 38134-3838
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Country | US
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Telephone | 901-837-0994
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Fax | 901-837-0999
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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 | 12892
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License Number State | TN
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