Individual
MRS. MARY ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2117 GENERAL BOOTH BLVD, VIRGINIA BEACH, VA 23454-5803
(757) 430-8739
Mailing address
3440 ARCHER CT, VIRGINIA BEACH, VA 23452-5911
(757) 498-9203
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2305002139
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305002139
STATE LICENSE NUMBER
VA
Enumeration date
04/25/2007
Last updated
07/08/2007
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