Tyler Peterson Peterson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

1334 N Whitman LN Ste 100
Liberty Lake, WA 99019-6034

Phone

(509) 924-1222

NPI assigned

Jul 16, 2018

Last updated

Jul 16, 2018By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1531699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531699200000",
    "number": "1093291700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22809 E COUNTRY VISTA DR APT 124",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197546",
            "telephone_number": "509-953-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 N WHITMAN LN STE 100",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990196034",
            "telephone_number": "509-924-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TYLER",
        "middle_name": "PETERSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-16",
        "last_updated": "2018-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph L Paventy, DMD
• Stephanie Morbeck Persondek, DO
• Geraldine Anne Peterdy, MD
• Noland Peterdy, PHARMD, JD, MBA
• Patrick C Peterson, PA-C
• Jacklyn Rose Petretee
• Heather Pincelli
• Cheralee K Pinnock, LMP
• Hazel Floranda Porter, RPH
• Proactive Health Chiropractic, Corp

• Physical Therapy Assistant in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; 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.