Healthcare Provider Details

I. General information

NPI: 1568997310
Provider Name (Legal Business Name): WILLIAM B PETERSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N YORK RD STE 11
HINSDALE IL
60521
US

IV. Provider business mailing address

PO BOX 220
WESTMONT IL
60559-0220
US

V. Phone/Fax

Practice location:
  • Phone: 630-819-8384
  • Fax: 630-468-0605
Mailing address:
  • Phone: 630-399-1015
  • Fax: 708-469-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023131
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: