Provider Demographics
NPI:1609097500
Name:PETERMAN, DANA A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:A
Last Name:PETERMAN
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 1:109 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1689
Mailing Address - Country:US
Mailing Address - Phone:478-994-3390
Mailing Address - Fax:478-994-3389
Practice Address - Street 1:109 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1689
Practice Address - Country:US
Practice Address - Phone:478-994-3390
Practice Address - Fax:478-994-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
65BBDHMedicare Oscar/Certification