Jonathon R Peterson, PT
Individual provider Active NPI Physical Therapist · Park Rapids, MN
NPI 1003008525 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1003008525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1585 (ND)
- Practice address
- 705 Pleasant Ave S
Park Rapids, MN 56470-1440 - Phone
- (218) 732-2800
- NPI assigned
- Aug 17, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Marys Regional Health Center
Practice addresses (Care Compare)
705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081223000307 | MN | Practitioner - Physical Therapist in Private Practice | 3476615691 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1585 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Marys Regional Health Center | Current | Accepting new patients | |
| St Mary'S Regional Health Center | Current |
Accepting new patients | |
| St Mary'S Regional Health Center | Current |
Accepting new patients |
Locations
1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
212 Aspen Ave NE
Menahga, MN 56464
Phone (218) 564-4131
705 Pleasant Ave S
Park Rapids, MN 56470
Phone (218) 732-2800
1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7998 | MN | |
| Physical Therapist | 225100000X | 1585 | ND | Yes |
Addresses
Primary practice location
705 Pleasant Ave S
Park Rapids, MN 56470-1440
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-4222
Other practice location 1
900 E Broadway Ave
Bismarck, ND 58501-4520
Phone (701) 530-8200
Other providers in Park Rapids, MN
- Park Rapids Physical Therapy and Rehabilitation Center Inc
- Park Rapids Walker Eye Clinic OD PA
- Peabody Chiropractic
- Michael Perez
- Anthony David Peterson
- Lisa Petrie
- Chasity Marie Phillips
- Brady Pieper
- Daniel Wayne Pifher
- Pinoniemi Chiropractic
All providers in Park Rapids, MN · Physical Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.