Individual
PHYLLIS LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT CHT
Contact information
Practice address
3112 N OCOEE ST, CLEVELAND, TN 37312
(423) 559-1537
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2590
TN
2251H1200X
Hand Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202418
BCBS OF TN
TN
Enumeration date
11/03/2006
Last updated
09/14/2015
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