| Organization Name: | PETERSON PHYSICAL THERAPY LLC |
| NPI Number: | 1316350077 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN PETERSON (OWNER/CLINICIAN) |
| Mailing Address: | 6770 Crain Hwy La Plata |
| State: | MD US |
| Postal Code: | 206464950 |
| Phone Number: | 4103710337 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 20342 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |