Organization
PETERSON THERAPY SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA PETERSON MA/CCC-SLP (OWNER)
(208) 584-1141
Entity
Organization
Contact information
Practice address
545 LINCOLN DR, IDAHO FALLS, ID 83401
(208) 584-1141
(888) 501-2591
Mailing address
545 LINCOLN DR, IDAHO FALLS, ID 83401-4118
(208) 584-1141
(888) 501-2591
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
07/31/2018
Last updated
08/01/2018
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