Provider Demographics
NPI:1356020069
Name:PETER, THERESA RENEE (DC, MS, CFMP)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:RENEE
Last Name:PETER
Suffix:
Gender:F
Credentials:DC, MS, CFMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 RINGLING BLVD UNIT 2745
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-8012
Mailing Address - Country:US
Mailing Address - Phone:312-248-2361
Mailing Address - Fax:
Practice Address - Street 1:12324 LOBELIA TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2933
Practice Address - Country:US
Practice Address - Phone:815-385-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor