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General NPI Number Information
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NPI Number | 1447648274
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Entity Type | Individual
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Provider Name | JESSICA R PETERSON PTA
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Gender | Female
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Dates
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Enumeration Date | 01/01/2015
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Last Update Date | 01/01/2015
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Provider Practice Location Address
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Address Line | 555 S PIERCE ST
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City | LAKEWOOD
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State | CO
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Zip | 80226-3470
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Country | US
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Telephone | 303-872-7427
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 W 84TH AVE APT 2828
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City | FEDERAL HEIGHTS
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State | CO
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Zip | 80260-4725
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Country | US
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Telephone | 630-750-6876
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 13354
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License Number State | CO
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