Individual
ANDREW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3025 W CHERRY LN STE D, MERIDIAN, ID 83642-8531
(208) 367-8593
Mailing address
121 E VICTORY RD APT A202, MERIDIAN, ID 83642-6915
(208) 731-5267
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7222
ID
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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