Provider Demographics
NPI:1861701807
Name:PETERSEN, ELENA J (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:J
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2935 S RECKER RD
Mailing Address - Street 2:ATTN: SPED
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7846
Mailing Address - Country:US
Mailing Address - Phone:480-279-7059
Mailing Address - Fax:
Practice Address - Street 1:2935 S RECKER RD
Practice Address - Street 2:ATTN: SPED
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7846
Practice Address - Country:US
Practice Address - Phone:480-279-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ89352251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics