Individual
MS. SUSAN ADELE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
30240 SW PARKWAY AVE STE 5, WILSONVILLE, OR 97070-9756
(503) 730-1785
Mailing address
30240 SW PARKWAY AVE STE 5, WILSONVILLE, OR 97070-9756
(503) 730-1785
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
10903
OR
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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