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General NPI Number Information
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NPI Number | 1023202561
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Entity Type | Individual
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Provider Name | PETER GERING SKUPEKO PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 1325 ELDRIDGE AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-5917
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Country | US
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Telephone | 651-639-1615
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Fax | 651-639-1615
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Provider Business Mailing Address
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Address Line | 2233 HAMLINE AVE N SUITE 215
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City | ROSEVILLE
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State | MN
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Zip | 55113-5009
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Country | US
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Telephone | 651-639-1625
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Fax | 651-639-1615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2548
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License Number State | MN
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