Individual
DENISE MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(252) 633-8640
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10786
NC
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018TE
BLUE CROSS GROUP BILLING NUMBER
NC
Enumeration date
02/06/2007
Last updated
03/04/2025
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