Provider Demographics
NPI:1134243033
Name:PETERSON, ROSEMARIE SAGABAEN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:SAGABAEN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 BRISCOE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5819
Mailing Address - Country:US
Mailing Address - Phone:515-227-0809
Mailing Address - Fax:
Practice Address - Street 1:3110 BRISCOE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5819
Practice Address - Country:US
Practice Address - Phone:515-227-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306330OtherPHYSICAL THERAPY LICENCE
IA03990OtherPHYSICAL THERAPY LICENSE