Provider Demographics
NPI:1912450644
Name:PETERS, DENISE (DPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PETERS
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 1:13610 BARRETT OFFICE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7818
Mailing Address - Country:US
Mailing Address - Phone:314-822-8107
Mailing Address - Fax:314-822-5106
Practice Address - Street 1:13610 BARRETT OFFICE DR STE 104
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7818
Practice Address - Country:US
Practice Address - Phone:314-822-8107
Practice Address - Fax:314-822-5106
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014017867OtherPT LICENSE #