Russel Peterson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3705 Issued in AZ

Practice address

420 S Main St
Snowflake, AZ 85937-5246

Phone

(928) 536-2357

NPI assigned

Jul 7, 2006

Last updated

Oct 24, 2007By the provider in NPPES

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 AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Mountain Physical Therapy LTDGroup PAC ID 0446142111, 15 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• White Mountain Physical Therapy LTD

  • Physical Therapist
  • Show Low, AZ
  • NPI 1750385654
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1063444933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 E SHOW LOW LAKE RD",
            "address_2": "SUITE 3",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S MAIN ST",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859375246",
            "telephone_number": "928-536-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RUSSEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "3705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynette Kay Nicoll
• Starr Penrod Ollerton, RN
• James Randall Olson, DDS
• Bobbye Jaelene Ortiz, FNP-BC
• Fredrick Bruce Packard, EDD
• Maggie B Price, PA-C
• Darwin Rawlins
• Cole B Rearden, PHARM. D.
• Kenneth Floyd Rice, D.M.D.
• Jennifer L Rivera, M.C., LPC

• Physical Therapist in Snowflake, AZ
• Providers in Snowflake, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.