Provider Demographics
NPI:1801973276
Name:PETERSON, DAVID SAMUEL (DPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SAMUEL
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8257
Mailing Address - Country:US
Mailing Address - Phone:256-837-5425
Mailing Address - Fax:256-837-2139
Practice Address - Street 1:147 CASTLE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8257
Practice Address - Country:US
Practice Address - Phone:256-837-5425
Practice Address - Fax:256-837-2139
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist