Healthcare Provider Details

I. General information

NPI: 1376756288
Provider Name (Legal Business Name): JAMES CALVIN PETERS M.ED., ATC, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-0991
  • Fax:
Mailing address:
  • Phone: 614-685-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA011030
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: