Individual
MRS. JACQUELINE LEE PETERSEN MOREHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPY
Contact information
Practice address
401 PHALEN BLVD, SAINT PAUL, MN 55101-5302
(651) 254-7729
Mailing address
1932 BAYARD AVE, SAINT PAUL, MN 55116-1215
(651) 699-8906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4267
MN
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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