Active NPI
Holly Anne Petersen, PT, DPT
- Physical Therapist
- Kingston, MA
National Provider Identifier
1114230547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 19130
- Practice address
- 186 Summer St
Kingston, MA 02364-1282 - Phone
- (781) 585-8588
- Fax
- (781) 585-1279
- NPI assigned
- Jul 14, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 19130 | MA | Primary |
Addresses
Primary practice location
186 Summer St
Kingston, MA 02364-1282
Mailing address
535 S Main St
2ND Floor
Randolph, MA 02368-5261
Phone (781) 961-3370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442448000000",
"number": "1114230547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 S MAIN ST",
"address_2": "2ND FLOOR",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023685261",
"telephone_number": "781-961-3370",
"fax_number": "781-767-7531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 SUMMER ST",
"city": "KINGSTON",
"state": "MA",
"postal_code": "023641282",
"telephone_number": "781-585-8588",
"fax_number": "781-585-1279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "HOLLY",
"middle_name": "ANNE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-14",
"last_updated": "2015-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "19130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.