Doctor Name: | DANE PETERSON |
NPI Number: | 1700250735 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT60599956 |
Business Practice Address: | 14028 Se Petrovitsky Rd Renton, WA - 980588933 |
Business Phone Number: | 4252720252 |
Business Fax Number: | 4252720291 |
Mailing Address: | 16083 Sw Upper Boones Ferry Rd, Suite 300 TIGARD |
State: | OR |
Postal Code: | 972247736 |
Phone Number: | 5034436156 |
Fax Number: | 5036399699 |
NPI Enumeration Date: | 11/13/2015 |
NPI Last Update Date: | 02/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT60599956 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
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 |