Provider Demographics
NPI:1073510327
Name:PETERSON, DEBRA E (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4306
Mailing Address - Country:US
Mailing Address - Phone:256-428-3000
Mailing Address - Fax:256-428-3003
Practice Address - Street 1:8415 WANN DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9534
Practice Address - Country:US
Practice Address - Phone:256-704-1700
Practice Address - Fax:256-704-1701
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917620Medicaid
AL1003819608OtherGROUP NPI
AL529917620Medicaid