Provider Demographics
NPI:1023421278
Name:PETERSEN, CLAIRE (DPT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CHATBURN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2010
Mailing Address - Country:US
Mailing Address - Phone:712-755-4342
Mailing Address - Fax:
Practice Address - Street 1:1213 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2010
Practice Address - Country:US
Practice Address - Phone:712-755-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist