Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 33770 | CA |
NPI | 1164779542 |
---|---|
Provider Name | Heather Petersen |
First Address | San Francisco, CA 94143-2202 |
Second Address | San Francisco, CA 94143-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2012 |
Last Update Date | 05/08/2012 |