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PETERSON PT LLC NPI 1669480968


NPI Information

NPI: 1669480968
Provider Name: PETERSON PT LLC

Former Legal Business Name: PETERSON PHYSICAL THERAPY

Classification: Pediatrics - 2080S0010X
Entity Type: Organization

Specialization: Sports Medicine

Address:
1320 W IRON SPRINGS RD
PRESCOTT, AZ
ZIP 86305
Phone: (928) 771-2977
Get Directions

PETERSON PT LLC is a sports medicine pediatrics in Prescott, AZ. The provider is a pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation. PETERSON PT LLC NPI is 1669480968. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Peterson Physical Therapy.

The provider's business location address is:

1320 W IRON SPRINGS RD
PRESCOTT, AZ
ZIP 86305-414
Phone: (928) 771-2977
Fax: (928) 771-2987

The provider's authorized official is Brek Lamont Peterson .
The authorized official title is Owner and has the following contact phone number (928) 771-2977.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 4/24/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080S0010XPediatricsSports Medicine5810ARIZONANo
22080S0010XPediatricsSports Medicine6499ARIZONANo
32080S0010XPediatricsSports Medicine5079ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Z64026MEDICARE UPINARIZONA
2P00468MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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