MEDICARE: PETERSON REHABILITATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT8041	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K1469	OTHER	FL	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1679584866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON REHABILITATION INC

Provider Business Mailing Address
First Line	:	5912 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4324
Country	:	US
Telephone Number	:	561-697-8800
Fax Number	:	561-697-3372

Provider Business Practice Location Address
First Line	:	5912 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4324
Country	:	US
Telephone Number	:	561-697-8800
Fax Number	:	561-697-3372

Authorized Official
Title or Position	:	CEO
Name	:	DR. ARTHUR PETERSON
Credential	:	PT, PHD
Telephone Number	:	561-697-8800

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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