Deniece P Petersen, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2999 Issued in NE

Practice address

325 S 1St Ave
Broken Bow, NE 68822-0435

Phone

(308) 872-5111

Fax

(308) 872-5115

NPI assigned

May 19, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Faith Regional Health Services

  dba Faith Health Professional Services

  • Emergency Medicine Physician
  • Norfolk, NE
  • NPI 1104854199

  Physical Therapist

  Medicare reassignment NPD
• Faith Regional Health Services

  dba The Pill Box

  • Community/Retail Pharmacy
  • Norfolk, NE
  • NPI 1699891465
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492732800000",
    "number": "1083025571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 S 1ST AVE",
            "address_2": "P.O. BOX 435",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688220435",
            "telephone_number": "308-872-5111",
            "fax_number": "308-872-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 S 1ST AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688220435",
            "telephone_number": "308-872-5111",
            "fax_number": "308-872-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DENIECE",
        "middle_name": "P",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-19",
        "last_updated": "2017-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "2999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12685767",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie K Olson
• Padc, LLC
• Jennifer Patterson
• Aubrey Elaine Patton
• Becky Jean Pearson, PT
• Justin Petersen
• Rachel Peterson, RDH
• Louella Delvon Porter
• Prairie Eyecare Center LLC
• Prairie Eyecare Center PC

• Physical Therapist in Broken Bow, NE
• Providers in Broken Bow, NE by specialty
• Physical Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.