Provider Demographics
NPI:1407047822
Name:PETERSEN, CHRIS L (DPT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:L
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 E 23RD ST
Mailing Address - Street 2:CP PHYSICAL THERAPY, P.C.
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2433
Mailing Address - Country:US
Mailing Address - Phone:402-727-1030
Mailing Address - Fax:402-727-4215
Practice Address - Street 1:1439 E 23RD ST
Practice Address - Street 2:CP PHYSICAL THERAPY, P.C.
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2433
Practice Address - Country:US
Practice Address - Phone:402-727-1030
Practice Address - Fax:402-727-4215
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02393OtherBLUE CROSS BLUE SHIELD
NEP00424755OtherRR MEDICARE
NE02393OtherBLUE CROSS BLUE SHIELD