Active NPI
Michael Carl Peterson, P.T.
- Physical Therapist
- Jamestown, NY
National Provider Identifier
1003062001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 016040-1
- Practice address
- 2850 Mitchell Rd
Jamestown, NY 14701-8906 - Phone
- (716) 487-1713
- NPI assigned
- Aug 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 016040-1 | NY | Primary |
Addresses
Primary practice location
2850 Mitchell Rd
Jamestown, NY 14701-8906
Mailing address
2850 Mitchell Rd
Jamestown, NY 14701-8906
Phone (716) 487-1713
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016040-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262822400000",
"number": "1003062001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2850 MITCHELL RD",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147018906",
"telephone_number": "716-487-1713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2850 MITCHELL RD",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147018906",
"telephone_number": "716-487-1713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MICHAEL",
"middle_name": "CARL",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-11",
"last_updated": "2010-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "016040-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.