PETERSON PT LLC (NPI# 1669480968) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669480968 |
| Entity Type | Organization |
| Organization Name | PETERSON PT LLC |
| Other Organization Name | PETERSON PHYSICAL THERAPY |
| Practice Address |
1320 W Iron Springs Rd Prescott AZ 86305-1414 |
| Practice Telephone | 9287712977 |
| Practice Fax Number | 9287712987 |
| Mailing Telephone | 9287712977 |
| Mailing Fax Number | 9287712987 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2017-04-24 |
| Authorized Official Name | MR. BREK LAMONT PETERSON (OWNER) |
| Authorized Official Telephone | 9287712977 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080S0010X |
Pediatrics Specialization: Sports Medicine |
5810 | AZ | Allopathic & Osteopathic Physicians |
| N | 2080S0010X |
Pediatrics Specialization: Sports Medicine |
6499 | AZ | Allopathic & Osteopathic Physicians |
| Y | 2080S0010X |
Pediatrics Specialization: Sports Medicine |
5079 | AZ | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Peterson Physical Therapy | Former Legal Business Name - Organization |
| Street Address |
1320 W IRON SPRINGS RD |
| City | PRESCOTT |
| State | AZ |
| Zip Code | 86305-1414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457671802 | Arches Ppt, LLC | Clinic/Center | 1320 W Iron Springs Rd, Prescott, AZ 86305-1414 | 2010-06-08 |
| 1083842447 | Christopher Cox Legler | Physical Therapist | 1320 W Iron Springs Rd, Prescott, AZ 86305-1414 | 2009-06-24 |
| 1518006444 | Brek Lamont Peterson | Physical Therapist | 1320 W Iron Springs Rd, Prescott, AZ 86305-1414 | 2007-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972005395 | Granite View Adult Care Home LLC | Assisted Living Facility | 7105 Williamson Valley Road, Prescott, AZ 86305 | 2018-03-01 |
| 1215468095 | Valerie Williams | Occupational Therapist | 926 S. Hinman Dr., Prescott, AZ 86305 | 2017-03-23 |
| 1174073837 | Caspian Gleam Medical Center LLC | Clinic/Center | 3130 Stillwater Drive, Suite B, Prescott, AZ 86305 | 2016-10-06 |
| 1114388634 | Marla Beth Perkins | Speech-Language Pathologist | 3160 Stillwater Dr., Prescott, AZ 86305 | 2016-03-10 |
| 1790159853 | Michele A. Bibeau, D.d.s. | Dentist | 1058 Fair Street, Suite A, Prescott, AZ 86305 | 2015-11-30 |
| 1609264837 | Integrative Pain Centres of Prescott | Pain Medicine | 3769 Crossings Drive, Suite B, Integrative Pain Centres of Prescott, Prescott, AZ 86305 | 2014-12-22 |
| 1649697251 | Sharon Marilyn Jackson | Counselor | 3636 Crossings Drive, Prescott, AZ 86305 | 2014-03-20 |
| 1215351259 | Stefanie Maneval | Registered Nurse | 900 Iron Springs Rd, Prescott, AZ 86305 | 2014-02-11 |
| 1508207523 | Recovery In The Pines, LLC | Community/Behavioral Health | 919 12th Place #13, Prescott, AZ 86305 | 2013-07-08 |
| 1871857359 | Neal Herbert Segovia Cabaluna | Internal Medicine | 3773 Crossings Dr Ste C, Prescott, AZ 86305 | 2012-06-28 |
| Find all providers in zip 86305 | ||||
| Taxonomy Code | 2080S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Sports Medicine |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871740241 | Mohammed Mortazavi | Pediatrics | 5199 E Farness Dr Ste 101, Tucson, AZ 85712 | 2008-08-27 |
| 1366723280 | Solstice Pediatrics and Sports Medicine, Plc | Pediatrics | 4731 S White Mountain Rd, Show Low, AZ 85901-7818 | 2011-09-06 |
| 1043473614 | Kristina Marie Wilson | Pediatrics | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2008-07-03 |
| 1760696025 | Arizona Sports Medicine Consultants PC | Pediatrics | 4530 N 32nd St, # 102, Phoenix, AZ 85018 | 2007-05-09 |
| 1184790214 | Michael Ralph Stilson | Pediatrics | 1224 E Lowell, Tucson, AZ 85721-0001 | 2006-11-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.