Provider Demographics
NPI:1326441726
Name:PETERSON, BRITTANY ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ROSE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-0688
Mailing Address - Country:US
Mailing Address - Phone:701-968-4411
Mailing Address - Fax:701-968-2574
Practice Address - Street 1:HIGHWAY 281 NORTH
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-0688
Practice Address - Country:US
Practice Address - Phone:701-968-2551
Practice Address - Fax:701-968-2574
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist