Individual
TALIA PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
101 KANANI RD, KIHEI, HI 96753-6805
(808) 633-4480
Mailing address
977 SLATE DR, SANTA ROSA, CA 95405-5592
(707) 280-4533
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5509
HI
Other
Enumeration date
08/11/2022
Last updated
08/11/2022
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