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General NPI Number Information
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NPI Number | 1699755546
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Entity Type | Individual
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Provider Name | RICKY L PETERSON PT
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 1701 48TH STREET SUITE 120
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City | WEST DES MOINES
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State | IA
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Zip | 50266-6723
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Country | US
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Telephone | 515-224-1474
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Fax | 515-224-1478
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Provider Business Mailing Address
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Address Line | 1701 48TH ST SUITE 120
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City | WEST DES MOINES
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State | IA
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Zip | 50266-6723
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Country | US
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Telephone | 515-224-1474
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Fax | 515-224-1478
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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 | 01473
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License Number State | IA
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