Individual
DENIECE P PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
325 S 1ST AVE, BROKEN BOW, NE 68822-0435
(308) 872-5111
(308) 872-5115
Mailing address
325 S 1ST AVE, P.O. BOX 435, BROKEN BOW, NE 68822-0435
(308) 872-5111
(308) 872-5115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2999
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12685767
CAQH
NE
Enumeration date
05/19/2014
Last updated
04/21/2017
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