Healthcare Provider Details

I. General information

NPI: 1740689561
Provider Name (Legal Business Name): CORY PETERSON P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

IV. Provider business mailing address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6516
  • Fax: 512-354-4068
Mailing address:
  • Phone: 512-710-6516
  • Fax: 512-355-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1248191
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: