Provider Demographics
NPI:1285658971
Name:PETERSON, AMY SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18430 HARVEST MEADOWS DR W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9122
Mailing Address - Country:US
Mailing Address - Phone:317-223-1520
Mailing Address - Fax:317-867-5891
Practice Address - Street 1:18430 HARVEST MEADOWS DR W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9122
Practice Address - Country:US
Practice Address - Phone:317-223-1520
Practice Address - Fax:317-867-5891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005576A225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200610670OtherFIRST STEPS