Individual
BRUCE E PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
625 9TH AVENUE, SUITE 220, LONGVIEW, WA 98632-2544
(360) 578-1188
(360) 578-6251
Mailing address
625 9TH AVENUE, SUITE 220, LONGVIEW, WA 98632-2544
(360) 578-1188
(360) 578-6251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00002292
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113275
KAISER PERMANENTE
WA
01
—
179681
DEPARTMENT OF LABOR & IND
WA
05
—
8345589
—
WA
01
—
8930118
CRIME VICTIMS
WA
01
—
932823
FIRST HEALTH
WA
01
—
K465803
PACIFIC SOURCE
WA
Enumeration date
07/07/2005
Last updated
07/11/2007
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