Greg Edward Petersen, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 20757 Issued in CA

Practice address

3878 W Carson St
Suite 100
Torrance, CA 90503-6707

Phone

(310) 543-4655

Fax

(310) 543-1743

NPI assigned

Sep 16, 2006

Sex

Male

Sole proprietor

No

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 CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1994

Medicare assignment

May accept Medicare assignment

Group practices

South Bay Sports Medicine Physical Therapy IncGroup PAC ID 0244262087, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• South Bay Sports Medicine Physical Therapy Inc.

  • Physical Therapist
  • Torrance, CA
  • NPI 1780770214
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013013176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3878 W CARSON ST",
            "address_2": "SUITE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905036707",
            "telephone_number": "310-543-4655",
            "fax_number": "310-543-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3878 W CARSON ST",
            "address_2": "SUITE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905036707",
            "telephone_number": "310-543-4655",
            "fax_number": "310-543-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GREG",
        "middle_name": "EDWARD",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 20757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter S. Borden, M.D., a Medical Corporation
• Peter S. Lorman, M.D., a Professonal Corp
• Brittany Peters
• Diane Yvonne Petersen, M.D.
• Ethan Merrill Petersen
• Patricia Mothner Petersen, LMFT
• Candace J Peterson-Kahn, MFT
• Lisa Rivo Peterson, PH.D.
• Michael A Peterson, M.D.
• Robert Earl Peterson, M.D.

• Physical Therapist in Torrance, CA
• Providers in Torrance, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.