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NPI Code Detail

MEDICARE: JARED L PETERSON PT

MEDICARE: JARED L PETERSON PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10801-024WI
2225100000XPhysical Therapist7495MN

General Provider Information

NPI Number : 1194968842
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED L PETERSON PT
Provider Business Mailing Address
First Line : 2530 BROADWAY AVE N
Second Line :
City : ROCHESTER
State : MN
Zip : 55906-1042
Country : US
Telephone Number : 507-259-7570
Fax Number : 888-624-3107
Provider Business Practice Location Address
First Line : 2530 BROADWAY AVE N
Second Line :
City : ROCHESTER
State : MN
Zip : 55906-4594
Country : US
Telephone Number : 507-259-7570
Fax Number : 888-624-3107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2009
Last Update Date : 12/14/2017

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