Provider Demographics
NPI:1346200367
Name:PETERSON, DEBORAH A (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:6821 N COUNTRY HOMES BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4372
Practice Address - Country:US
Practice Address - Phone:509-325-6776
Practice Address - Fax:509-325-0817
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT2996174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650010188OtherRAILROAD MEDICARE
GAB37906OtherMEDICARE PROVIDER
WA0038860OtherSTATE L&I
WA650010188Medicare ID - Type UnspecifiedRAILROAD MEDICARE
650010188OtherRAILROAD MEDICARE
WAAB37906Medicare ID - Type Unspecified