Peterson Performance Products, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PETERSON PERFORMANCE PRODUCTS, INC.

Practice address

2200 NE Neff Rd
Suite 307
Bend, OR 97701-4283

Phone

(541) 617-1505

Fax

(541) 617-1527

NPI assigned

Jun 8, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Melody Anne Peterson, C. PED., LMT

Title

Co-Owner, Vice President, Sec/Treas

Phone

(541) 617-1505

Specialties & licenses 1

Addresses

Other names 1

• Foot Fitness Doing business as

Tax ID family

Foot Fitness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peterson Performance Products Inc

  • Customized Equipment (DME)
  • Bend, OR
  • NPI 1568758282
  NPD tax ID

Locations

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003856816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "address_2": "SUITE 307",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283",
            "telephone_number": "541-617-1505",
            "fax_number": "541-617-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "address_2": "SUITE 307",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283",
            "telephone_number": "541-617-1505",
            "fax_number": "541-617-1527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PERFORMANCE PRODUCTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MELODY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CO-OWNER, VICE PRESIDENT, SEC/TREAS",
        "authorized_official_telephone_number": "541-617-1505",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C. PED., LMT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foot Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daisha Marie Peters
• Gerald E Peters Jr., M.D.
• Emily Petersen
• Kiana Kay Shin-Tze Petersen
• Peterson Performance Products Inc
• Jake Allen Peterson, DDS, MD
• Jodi Peterson
• Johanna Rae Peterson, PA-C
• Lindsey Peterson, PA-C
• Sarah Elizabeth Peterson, LCSW

• Durable Medical Equipment & Medical Supplies in Bend, OR
• Providers in Bend, OR by specialty
• Durable Medical Equipment & Medical Supplies in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.