Individual
MR. EVAN J PETERSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT, OCS, ATC, CSCS
Contact information
Practice address
3851 ROGER BROOKE DR, BLDG 3600, FORT SAM HOUSTON, TX 78234-4501
(210) 916-1920
(210) 916-4074
Mailing address
4601 RED ROCK PASS, SCHERTZ, TX 78154-1123
(210) 455-3687
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
3803
SC
Other
Enumeration date
10/31/2005
Last updated
07/08/2007
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