NPIMap

Individual provider Active NPI

Susan Peterson, PT

  • Physical Therapist
  • La Plata, MD
National Provider Identifier
1104908540
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
134 Drury Dr
La Plata, MD 20646-4241
Phone
(301) 539-3807
Fax
(301) 539-3814
NPI assigned
Oct 19, 2006
Last updated
Jun 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

134 Drury Dr
La Plata, MD 20646-4241

Mailing address

PO Box 102
La Plata, MD 20646-0102
Phone (301) 539-3807

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060330000384 MD Practitioner - Physical Therapist in Private Practice 7315955440 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Maryland School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peterson Physical Therapy LLCGroup PAC ID 7214158237, 4 clinicians

Practice addresses (Care Compare)

144 Drury Dr
La Plata, MD 20646-4241
Phone (301) 539-3807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peterson Physical Therapy LLC CurrentSince Jan 1, 2014 Accepting new patients
Civista Medical Center, Inc. Physical Therapist CurrentSince Jan 20, 2015 Accepting new patients
Civista Medical Center, Inc. CurrentSince Jan 20, 2015 Accepting new patients
Civista Medical Center Inc Current Accepting new patients
Orthopedic & Sports Physical Therapy Physical Therapist PastSince Jun 20, 2016 Accepting new patients
Calvert Physical Therapy and Sports Fitness Ctr. Physical Therapist Past Accepting new patients

Locations

134 Drury Dr
La Plata, MD 20646
Phone (301) 539-3807

144 Drury Dr
La Plata, MD 20646
Phone (301) 539-3807

5 Garrett Ave
La Plata, MD 20646
Phone (301) 609-4000

701 Charles St
La Plata, MD 20646
Phone (301) 609-4000

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1104908540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206460102",
            "telephone_number": "301-539-3807",
            "fax_number": "301-539-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 DRURY DR",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206464241",
            "telephone_number": "301-539-3807",
            "fax_number": "301-539-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "SUSAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.