# PETERSON PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316350077
- **Authorized official:** MRS. SUSAN PETERSON P.T. (OWNER/CLINICIAN)
- **Authorized official phone:** (410) 371-0337

## Contact information

- **Practice address:** 144 DRURY DR, LA PLATA, MD 20646-4241
- **Practice address phone:** (410) 371-0337
- **Practice address fax:** (301) 539-3814
- **Mailing address:** PO BOX 102, LA PLATA, MD 20646-0102
- **Mailing address phone:** (301) 539-3807
- **Mailing address fax:** (301) 539-3814

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 20342 | MD | Yes |

## Other

- **Enumeration date:** 06/10/2014
- **Last updated:** 12/10/2020