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NPI Code Detail

MEDICARE: LEVI PETERSON

MEDICARE: LEVI PETERSON
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 Therapist11298MN
2225100000XPhysical TherapistPT298609CA

General Provider Information

NPI Number : 1538648357
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEVI PETERSON
Provider Business Mailing Address
First Line : 1106 WALNUT ST STE 110
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2416
Country : US
Telephone Number : 805-788-0805
Fax Number : 805-788-0845
Provider Business Practice Location Address
First Line : 4869 S BRADLEY RD STE 114
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-5088
Country : US
Telephone Number : 805-938-5320
Fax Number : 805-938-5390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 09/21/2022

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1639834591 — GABRIEL KING PT
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Directions to “ LEVI PETERSON ” Practice Location

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