Individual
RUSSEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 S MAIN ST, SNOWFLAKE, AZ 85937-5246
(928) 536-2357
Mailing address
2650 E SHOW LOW LAKE RD, SUITE 3, SHOW LOW, AZ 85901-7955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3705
AZ
Other
Enumeration date
07/07/2006
Last updated
10/24/2007
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