Individual
MR. BREK LAMONT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1320 W IRON SPRINGS RD, PRESCOTT, AZ 86305-1414
(928) 771-2977
(928) 771-2987
Mailing address
1320 W IRON SPRINGS RD, PRESCOTT, AZ 86305-1414
(928) 771-2977
(928) 771-2987
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5079
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669480968
NPI
AZ
Enumeration date
02/06/2007
Last updated
07/09/2007
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