Provider Demographics
NPI:1578840484
Name:PETERSON, CHRISTY SUE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:SUE
Last Name:PETERSON
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 1:47581 815TH RD
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-5362
Mailing Address - Country:US
Mailing Address - Phone:308-730-1331
Mailing Address - Fax:308-728-5644
Practice Address - Street 1:47581 815TH RD
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-5362
Practice Address - Country:US
Practice Address - Phone:308-730-1331
Practice Address - Fax:308-728-5644
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist