Provider Demographics
NPI:1467437244
Name:PETERSEN, BARBARA JACQUELINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JACQUELINE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2840 GRAYHAWK CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3414
Mailing Address - Country:US
Mailing Address - Phone:503-399-5411
Mailing Address - Fax:
Practice Address - Street 1:290 MOYER LN NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3822
Practice Address - Country:US
Practice Address - Phone:503-370-8990
Practice Address - Fax:503-363-4214
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics