Provider Demographics
NPI:1386474500
Name:PETTERSEN, ALEXIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:PETTERSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-2240
Mailing Address - Country:US
Mailing Address - Phone:406-989-0327
Mailing Address - Fax:
Practice Address - Street 1:672 E WYTHE CREEK CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5216
Practice Address - Country:US
Practice Address - Phone:208-922-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist