MEDICARE: SOUTH SOUND HEALTH & FITNESS

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1396914628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SOUND HEALTH & FITNESS

Provider Business Mailing Address
First Line	:	2960 A LIMITED LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502
Country	:	US
Telephone Number	:	360-943-9570
Fax Number	:	360-754-4517

Provider Business Practice Location Address
First Line	:	2960 A LIMITED LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502
Country	:	US
Telephone Number	:	360-943-9570
Fax Number	:	360-754-4517

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	MR. JON T PETERSON
Credential	:	DO
Telephone Number	:	360-709-9500

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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Directions to “SOUTH SOUND HEALTH & FITNESS ” Practice Location

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