Provider Demographics
NPI:1679198329
Name:PETERS, KATHERINE P (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:P
Last Name:PETERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:P
Other - Last Name:BREEZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5860 YADKIN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2668
Mailing Address - Country:US
Mailing Address - Phone:910-491-5164
Mailing Address - Fax:910-229-3227
Practice Address - Street 1:5860 YADKIN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2668
Practice Address - Country:US
Practice Address - Phone:910-491-5164
Practice Address - Fax:910-229-3227
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP014650T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist