Justin Daniel Peterson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61183342 Issued in WA

Practice address

9516 State Ave Ste B
Marysville, WA 98270-2277

Phone

(360) 658-8857

Fax

(360) 659-8296

NPI assigned

Feb 7, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NSPT IncGroup PAC ID 5698850295, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NSPT, Inc.

  • Physical Therapy Clinic/Center
  • Stanwood, WA
  • NPI 1336326198

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• NSPT, Inc.

  • Physical Therapy Clinic/Center
  • Snohomish, WA
  • NPI 1457063984

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1003560384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 TUMWATER BLVD SE STE 113",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016422",
            "telephone_number": "360-528-3300",
            "fax_number": "360-528-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9516 STATE AVE STE B",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982702277",
            "telephone_number": "360-658-8857",
            "fax_number": "360-659-8296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JUSTIN",
        "middle_name": "DANIEL",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-07",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61183342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Performance Chiropractic
• Cayley Jeanne Perman-Marshall
• Cary Leigh Peterson, LMHC
• Chelsea Peterson, SLP
• Elaine Mae Peterson, D.O.
• Kathleen Ann Peterson, OTR/L
• Lyubov Petrushak
• Dylan Pettit
• Larry Lee Pevny, DENTURIST
• Jessica Pham

• Physical Therapist in Marysville, WA
• Providers in Marysville, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.