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General NPI Number Information
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NPI Number | 1487223145
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Entity Type | Individual
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Provider Name | HANNAH PETERSON PTA
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Gender | Female
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 14002 E 21ST ST STE 650
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City | TULSA
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State | OK
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Zip | 74134-1425
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Country | US
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Telephone | 405-355-3239
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Fax |
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Provider Business Mailing Address
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Address Line | 2454 S BENEDICT RD
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City | LUDINGTON
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State | MI
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Zip | 49431-9332
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Country | US
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Telephone | 231-233-2571
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502005825
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License Number State | MI
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