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Contact Information

PETERSON PT LLC
1320 W IRON SPRINGS RD
PRESCOTT, AZ86305-1414
 Phone: 928-771-2977
 Fax: 928-771-2987
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

2080S0010X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PETERSON PT LLC

NPI # 1669480968
LBN Legal business name PETERSON PT LLC
Authorized official BREK PETERSON - (OWNER/PHYSICAL THERAPIST)
Entity Organization
Organization subpart 1 No
Enumeration date 08/03/2006
Last updated 05/20/2024 - About 2 years ago
Identifiers
AZ License # 5079
AZ License # 5810
AZ License # 6499
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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