Provider Demographics
NPI:1629558788
Name:PETERS, VIRGIE M (ITDS)
Entity Type:Individual
Prefix:
First Name:VIRGIE
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5228
Mailing Address - Country:US
Mailing Address - Phone:181-350-3988
Mailing Address - Fax:
Practice Address - Street 1:1815 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5228
Practice Address - Country:US
Practice Address - Phone:181-350-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist