| NPI | 1669480968 |
|---|---|
| Former Legal Business Name | PETERSON PHYSICAL THERAPY |
| Entity Type | Organization |
| Authorized Contact | BREK LAMONT PETERSON Owner/Physical Therapist 928-771-2977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 5079) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 5810) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 6499) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-05-20 |