Individual
STEPHANIE ANN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
100 LINDSEY LN # A, KINGSLAND, GA 31548-6850
(912) 729-1333
(912) 729-5259
Mailing address
PO BOX 949, ROME, GA 30162-0949
(706) 236-2774
(706) 802-1408
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002706
GA
Other
Enumeration date
01/05/2012
Last updated
01/05/2012
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