Individual
BETHANY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
Mailing address
1040 ENSLEY AVE APT 109, NORTHFIELD, MN 55057-3307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
808054707
MEDICA
—
Enumeration date
04/20/2018
Last updated
04/20/2018
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