Blake Hammond Petersen, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2018022252 Issued in MO

Practice address

5400 N Oak Trfy Ste 103
Kansas City, MO 64118-4689

Phone

(816) 455-0301

NPI assigned

Jun 29, 2018

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 MO, KS2 enrollments

Enrollment records 2

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.

• Arc Physical Therapy Plus LP

  • Physical Therapist
  • Overland Park, KS
  • NPI 1851715353

  MO

  Medicare reassignment NPD
• Arc Physical Therapy Plus LP

  • Durable Medical Equipment & Medical Supplies
  • Kansas City, MO
  • NPI 1568180545
  NPD

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1063907129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 N OAK TRFY STE 103",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184689",
            "telephone_number": "816-455-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 N OAK TRFY STE 103",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184689",
            "telephone_number": "816-455-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "BLAKE",
        "middle_name": "HAMMOND",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-29",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2018022252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry B. Peters, L.C.S.W.
• Louis Joseph Peters Jr., MS DMIN
• Megan Peters
• Rachal Nicola Peters, RN
• Sarah Elizabeth Peters, RD
• Eric William Richard Petersen
• Samantha Shea Petersen
• Bethany Peterson, PT, DPT
• Carol B. Peterson, LCSW
• Carrie Ann Peterson

• Physical Therapist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.