Provider Demographics
NPI:1174147094
Name:PETERSEN, DANIELLE SPENCER (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SPENCER
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 STAGE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3838
Mailing Address - Country:US
Mailing Address - Phone:901-837-0994
Mailing Address - Fax:901-837-0999
Practice Address - Street 1:11680 HIGHWAY 51 S STE A-1
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7604
Practice Address - Country:US
Practice Address - Phone:901-837-0994
Practice Address - Fax:901-837-0999
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12892225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9607OtherPT LICENSURE