Provider Demographics
NPI:1477237113
Name:PETERSEN, MIKAYLA PATRICIA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:PATRICIA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:MIKAYLA
Other - Middle Name:PATRICIA
Other - Last Name:MCMANIMON GARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1173 ROCK SPRINGS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8414
Mailing Address - Country:US
Mailing Address - Phone:615-220-5796
Mailing Address - Fax:615-220-8829
Practice Address - Street 1:388 HARDING PL STE A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3928
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:615-220-8829
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT32960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty