Individual
JEFFREY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
(208) 267-1747
Mailing address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
(208) 267-1747
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2720
ID
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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