Most Relevant Information
Provider Data
| NPI Number: | 1003560384 |
| Provider Name: | JUSTIN DANIEL PETERSON PT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | PT61183342 |
Most Important Dates
| Enumeration Date: | 02/07/2022 |
| Last Updated: | 03/21/2023 |
Provider Practice Location
9516 STATE AVE STE B
MARYSVILLE
WA
982702277
Practice Location Phone/Fax
| Phone: | 3606588857 |
| Fax: | 3606598296 |
Provider Mailing Location
111 TUMWATER BLVD SE STE 113
TUMWATER
WA
985016422
Provider Mailing Phone/Fax
| Phone: | 3605283300 |
| Fax: | 3605288162 |