Individual
MR. SHANE MICHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
3300 19TH AVENUE, FOREST GROVE, OR 97116
(503) 357-7119
(503) 992-2097
Mailing address
#560 SE INTERNATIONAL WAY, STE. 100, MILWAUKIE, OR 97222
(971) 206-5200
(971) 206-5203
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06407
OR
Other
Enumeration date
02/04/2011
Last updated
02/04/2011
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