MEDICARE: MRS. JULIE PETERSEN-HANSON PT

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	2251X0800X	Orthopedic Physical Therapist	10645	CO

General Provider Information

NPI Number	:	1588992903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE PETERSEN-HANSON PT

Provider Business Mailing Address
First Line	:	4440 ARAPAHOE AVE STE 101
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-9101
Country	:	US
Telephone Number	:	303-444-2529
Fax Number	:	303-444-2563

Provider Business Practice Location Address
First Line	:	4440 ARAPAHOE AVE STE 101
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-9101
Country	:	US
Telephone Number	:	303-444-2529
Fax Number	:	303-444-2563

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

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	02/26/2020

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