Provider Demographics
NPI:1508406927
Name:PETERS, ANGELA JOSEFINA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOSEFINA
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 LADY FERN LOOP NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3286
Mailing Address - Country:US
Mailing Address - Phone:360-451-5349
Mailing Address - Fax:
Practice Address - Street 1:3422 LADY FERN LOOP NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-3286
Practice Address - Country:US
Practice Address - Phone:360-451-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant