Active NPI
Matthew Bain Petersen, DPT
- Physical Therapist
- Mishawaka, IN
National Provider Identifier
1023933462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05016475A
- Practice address
- 200 N Church St Ste 101
Mishawaka, IN 46544-1423 - Phone
- (574) 807-9995
- Fax
- (574) 259-1506
- NPI assigned
- Aug 13, 2026
- Sex
- Male
- Sole proprietor
- No
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 | 05016475A | IN | Primary |
Addresses
Primary practice location
200 N Church St Ste 101
Mishawaka, IN 46544-1423
Mailing address
200 N Church St Ste 101
Mishawaka, IN 46544-1423
Phone (574) 807-9995
Other practice location 1
12788 State Road 23
Granger, IN 46530-7893
Phone (574) 271-1434
Other practice location 2
300 S Saint Louis Blvd Ste 203
South Bend, IN 46617-3044
Phone (574) 234-1059
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rci (WRS), LLC. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786579200000",
"number": "1023933462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 N CHURCH ST STE 101",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441423",
"telephone_number": "574-807-9995",
"fax_number": "574-259-1506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N CHURCH ST STE 101",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441423",
"telephone_number": "574-807-9995",
"fax_number": "574-259-1506"
}
],
"practiceLocations": [
{
"address_1": "12788 State Road 23",
"address_purpose": "LOCATION",
"city": "Granger",
"state": "IN",
"postal_code": "465307893",
"country_code": "US",
"telephone_number": "574-271-1434",
"fax_number": "574-271-1536",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 S Saint Louis Blvd Ste 203",
"address_purpose": "LOCATION",
"city": "South Bend",
"state": "IN",
"postal_code": "466173044",
"country_code": "US",
"telephone_number": "574-234-1059",
"fax_number": "574-234-1068",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "MATTHEW",
"middle_name": "BAIN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-08-13",
"last_updated": "2026-08-13",
"certification_date": "2026-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05016475A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.