Individual
JARVARIUS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10300 COURTHOUSE RD, CHESTERFIELD, VA 23832
(804) 203-1991
Mailing address
5613 BELL ST, NORTH DINWIDDIE, VA 23803-8933
(804) 926-6461
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306604599
VA
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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