Individual
MRS. CONSTANCE V PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1095
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4005129
BLUECROSS BLUESHIELD
TN
05
—
5440745
—
TN
Enumeration date
07/07/2006
Last updated
07/08/2007
Update your record
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