Individual
DIANE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-9462
Mailing address
112 E 5TH AVE, ANTIGO, WI 54409-2710
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1969-024
WI
Other
Enumeration date
05/01/2009
Last updated
05/01/2009
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