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NPI Code Detail

MEDICARE: STACY PETERSON

MEDICARE: STACY 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
1224Y00000XClinical Exercise PhysiologistMN

General Provider Information

NPI Number : 1851246789
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY PETERSON
Provider Business Mailing Address
First Line : 4738 MAAS CT
Second Line :
City : MINNETRISTA
State : MN
Zip : 55375-4404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1095 HIGHWAY 15 S
Second Line :
City : HUTCHINSON
State : MN
Zip : 55350-5000
Country : US
Telephone Number : 320-234-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ STACY PETERSON ” Practice Location

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