Healthcare Provider Details

I. General information

NPI: 1588739759
Provider Name (Legal Business Name): ERIK PETERSON PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CUTTER CT
EAST HAMPTON NY
11937-6408
US

IV. Provider business mailing address

5 CUTTER CT
EAST HAMPTON NY
11937-6408
US

V. Phone/Fax

Practice location:
  • Phone: 631-235-8944
  • Fax:
Mailing address:
  • Phone: 631-235-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023533-1
License Number StateNY

VIII. Authorized Official

Name: MR. ERIK PETERSON
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 631-235-8944