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NPI Code Detail

MEDICARE: EMILY ERIN PETERSON DPT

MEDICARE: EMILY ERIN PETERSON DPT
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 Therapist06668OR

General Provider Information

NPI Number : 1922382381
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ERIN PETERSON DPT
Provider Business Mailing Address
First Line : 3810 SE CENTER ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3209
Country : US
Telephone Number : 503-895-1320
Fax Number :
Provider Business Practice Location Address
First Line : 7203 SE RAYMOND ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-4323
Country : US
Telephone Number : 503-895-1320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2011
Last Update Date : 11/30/2011

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