Healthcare Provider Details

I. General information

NPI: 1679028534
Provider Name (Legal Business Name): ANDREW PETERSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320B CHARLES H DIMMOCK PKWY STE 6
COLONIAL HEIGHTS VA
23834-2938
US

IV. Provider business mailing address

320B CHARLES H DIMMOCK PKWY STE 6
COLONIAL HEIGHTS VA
23834-2938
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-0533
  • Fax:
Mailing address:
  • Phone: 804-524-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT291814
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: