Individual provider Active NPI

Jesse Robert Peterson, DPT

  • Clinical Electrophysiology Physical Therapist
  • San Antonio, TX
National Provider Identifier
1104571256
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Electrophysiology Physical TherapistTaxonomy code 2251E1300X
License
1408526 Issued in TX
Practice address
3327 Research PLZ Ste 215
San Antonio, TX 78235-5157
Phone
(210) 804-5400
NPI assigned
Feb 17, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Electrophysiology Physical Therapist 2251E1300X 1408526 TX Primary

Addresses

Primary practice location

3327 Research PLZ Ste 215
San Antonio, TX 78235-5157

Mailing address

400 Concord Plaza Dr Ste 300
San Antonio, TX 78216-6991
Phone (210) 804-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926002029 ID Practitioner - Physical Therapist in Private Practice 3072909134 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Land Rehabilitation LLCGroup PAC ID 9234048745, 207 clinicians

Practice addresses (Care Compare)

8727 W Ardene St
Suite 102G
Boise, ID 83709-2627
Phone (208) 322-6200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
McDonald Rehab, PC Physical Therapist CurrentSince Jun 27, 2022 Accepting new patients
Mountain Land Rehabilitation LLC Physical Therapist CurrentSince Apr 1, 2025 Accepting new patients

Locations

1435 S Maple Grove Rd
Boise, ID 83709
Phone (208) 322-6200

1961 S Broadway Ave
Boise, ID 83706
Phone (208) 344-1851

8727 W Ardene St
Ste 102G
Boise, ID 83709
Phone (208) 322-6200

4623 Enterprise Way
Caldwell, ID 83605
Phone (208) 455-4231

912 S Washington Ave
Emmett, ID 83617
Phone (208) 365-4400

2210 Coronado St
Idaho Falls, ID 83404
Phone (208) 317-3956

1680 E 1st St
Idaho Falls, ID 83401
Phone (208) 417-0090

3345 Potomac Way
Idaho Falls, ID 83404
Phone (208) 417-0090

672 E Wythe Creek Ct
Ste 103
Kuna, ID 83634
Phone (208) 922-9828

1450 E Fairview Ave
#201
Meridian, ID 83642
Phone (208) 887-6757

5251 E Exchange Way
Nampa, ID 83687
Phone (208) 466-9642

1800 Flandro Dr
Ste 190
Pocatello, ID 83202
Phone (208) 233-2248

128 Vista Dr
Pocatello, ID 83201
Phone (208) 233-2248

370 N Haven Dr
Ste 102
Twin Falls, ID 83301
Phone (208) 398-3776

Organizations & group practices 2

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": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1104571256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CONCORD PLAZA DR STE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782166991",
            "telephone_number": "210-804-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 RESEARCH PLZ STE 215",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782355157",
            "telephone_number": "210-804-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JESSE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-17",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251E1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "TX",
            "license": "1408526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; 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.