Provider Demographics
NPI:1346210945
Name:PETERSEN, ANGELA RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:PETERSEN
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 1:2725 S 144TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5243
Mailing Address - Country:US
Mailing Address - Phone:402-637-0750
Mailing Address - Fax:402-637-0754
Practice Address - Street 1:2725 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5243
Practice Address - Country:US
Practice Address - Phone:402-637-0750
Practice Address - Fax:402-637-0754
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist