Provider Demographics
NPI:1851679211
Name:PETERS, CHARISSA L (DPT)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:L
Other - Last Name:NORDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:170 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4132
Mailing Address - Country:US
Mailing Address - Phone:717-299-4871
Mailing Address - Fax:717-391-2494
Practice Address - Street 1:170 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:717-391-2494
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist