MEDICARE: MS. INGRID PEETERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006310L	PA

General Provider Information

NPI Number	:	1558640680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INGRID PEETERS

Provider Business Mailing Address
First Line	:	1323 FREEDOM RD
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 FREEDOM RD
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2011
Last Update Date	:	08/07/2011

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