Provider Demographics
NPI:1518313006
Name:PETERSEN, HANNAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 COUNTY ROAD 27 SW
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MN
Mailing Address - Zip Code:56327-8207
Mailing Address - Country:US
Mailing Address - Phone:907-687-8050
Mailing Address - Fax:
Practice Address - Street 1:11081 COUNTY ROAD 27 SW
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MN
Practice Address - Zip Code:56327-8207
Practice Address - Country:US
Practice Address - Phone:907-687-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9007171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor