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General NPI Number Information
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NPI Number | 1194968842
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Entity Type | Individual
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Provider Name | JARED L PETERSON PT
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Gender | Male
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 2530 BROADWAY AVE N
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City | ROCHESTER
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State | MN
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Zip | 55906-4594
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Country | US
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Telephone | 507-259-7570
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Fax | 888-624-3107
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Provider Business Mailing Address
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Address Line | 2530 BROADWAY AVE N
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City | ROCHESTER
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State | MN
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Zip | 55906-1042
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Country | US
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Telephone | 507-259-7570
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Fax | 888-624-3107
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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 | 10801-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7495
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License Number State | MN
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