Provider Demographics
NPI:1932517141
Name:PETERSEN, HAELEY BROOKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HAELEY
Middle Name:BROOKE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 W GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-4449
Mailing Address - Country:US
Mailing Address - Phone:402-380-4299
Mailing Address - Fax:
Practice Address - Street 1:5930 VANDERVOORT DR
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2391
Practice Address - Country:US
Practice Address - Phone:402-420-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist