Petersen, Shannon Marie

Petersen, Shannon Marie is an individual health care provider with primary practice located at 3200 Grand Ave , Des Moines IA 50312-4104. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Petersen, Shannon Marie can be contacted via phone (515) 271-1717.

Contact Information

Primary practice address
3200 Grand Ave Des Moines IA 50312-4104
Phone: (515) 271-1717
Fax: (515) 271-7185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 02411 Iowa

Profile Details

NPI number 1619969383
LBN Legal business name Petersen, Shannon Marie
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2005
Last updated Mar 4th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619969383 NPPES
Iowa MEDICAID 0299826

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