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Individual

COREY NATHANIEL PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1227 E 32ND ST, STE 7, JOPLIN, MO 64804-2880
(417) 624-7400
(417) 624-7403
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1259336
TX
225100000X
Physical Therapist
Primary
2015017587
MO

Other

Enumeration date
05/28/2015
Last updated
06/09/2015
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