Provider Demographics
NPI:1679198089
Name:PETERSEN, JULIE ANNE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:PETERSEN
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 1:7505 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3692
Mailing Address - Country:US
Mailing Address - Phone:303-805-5156
Mailing Address - Fax:
Practice Address - Street 1:7505 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-3692
Practice Address - Country:US
Practice Address - Phone:303-805-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist