| Doctor Name: | PETRA S PLACE |
| NPI Number: | 1023184306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PT-21919 |
| Business Practice Address: | 25982 Pala Suite 230 Mission Viejo, CA - 926916719 |
| Business Phone Number: | 9496008812 |
| Business Fax Number: | |
| Mailing Address: | 8259 Wicker Ave, SAINT JOHN |
| State: | IN |
| Postal Code: | 463738878 |
| Phone Number: | 2193656553 |
| Fax Number: | |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-21919 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |