Individual
DANE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
14028 SE PETROVITSKY RD, RENTON, WA 98058-8933
(425) 272-0252
(425) 272-0291
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(503) 443-6156
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60599956
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0349712
WA L&I
WA
05
—
1700250735
—
WA
Enumeration date
11/13/2015
Last updated
02/25/2016
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