Individual
DR. JACOB PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2160 APPIAN WAY, SUITE 101, PINOLE, CA 94564-2576
(510) 724-1248
Mailing address
8874 WOODMAYR CIR, NORWALK, IA 50211-1842
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
291765
CA
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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