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Individual

CAMILLE DIMONTE PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T., DPT

Contact information

Practice address
2383 STATE HIGHWAY 17, PHELPS, WI 54554-9472
(715) 545-3886
(715) 545-3412
Mailing address
1476 US HIGHWAY 2, CRYSTAL FALLS, MI 49920-9628
(906) 875-3083

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4377-024
WI
225100000X
Physical Therapist
Primary
5501004807
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
40203800
MEDICAID
WI
05
4673910
MI
Enumeration date
09/11/2006
Last updated
04/28/2009
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