Individual
LACEY MARIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPTA
Contact information
Practice address
1807 PASO ROBLE WAY, MADISON, WI 53716-2418
(605) 267-0314
Mailing address
PO BOX 367, 249 E 1ST ST, PARKER, SD 57053
(605) 297-2442
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0174
SD
Other
Enumeration date
10/15/2007
Last updated
10/15/2007
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