Provider Demographics
NPI:1801018635
Name:PETERSON, NANCY MARIE (MPT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9576
Mailing Address - Country:US
Mailing Address - Phone:831-768-8182
Mailing Address - Fax:
Practice Address - Street 1:7101 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6615
Practice Address - Country:US
Practice Address - Phone:408-842-6868
Practice Address - Fax:408-842-2276
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist