Provider Demographics
NPI:1073721528
Name:PETERMAN, DOUGLAS EARL (RPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:EARL
Last Name:PETERMAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BROOKMOORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:16 OFFICE PARK DR
Practice Address - Street 2:SUITE 21
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6020
Practice Address - Country:US
Practice Address - Phone:601-336-7155
Practice Address - Fax:601-336-7782
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist