Individual
ANGELINE M PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1588 W CAYUSE CREEK DR STE 110, MERIDIAN, ID 83646-4795
(208) 515-7575
(208) 515-7578
Mailing address
1588 W CAYUSE CREEK DR STE 110, MERIDIAN, ID 83646-4795
(208) 515-7575
(208) 515-7578
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3198
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT3198
IDAHO LICENSE
ID
Enumeration date
06/01/2017
Last updated
07/25/2018
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