Jordan B Peterson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11996 Issued in MN

Practice address

3835 Supreme CT NW Ste 2
Bemidji, MN 56601-4485

Phone

(218) 444-8280

Fax

(218) 444-8337

NPI assigned

Aug 13, 2020

Sex

Female

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 MN

Enrollment records 1

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.

• Choice Therapy, P.a.

  • Rehabilitation Clinic/Center
  • Bemidji, MN
  • NPI 1831325620

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1114538170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3835 SUPREME CT NW STE 2",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014485",
            "telephone_number": "218-444-8280",
            "fax_number": "218-444-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3835 SUPREME CT NW STE 2",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014485",
            "telephone_number": "218-444-8280",
            "fax_number": "218-444-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JORDAN",
        "middle_name": "B",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "11996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pedro Isaac Perez, M.D.
• Kelly-Ann Peters, MS CCC-SLP, CLC
• Heather Marie Petersen, LPCC
• Christian M Peterson, M.D.
• Craig Peterson
• Katie Louise Peterson, DDS
• Meghan Peterson, LICSW
• Nancy Jo Peterson, MS CCC SLP
• Robin Peterson, LPN
• Travis Peterson

• Physical Therapist in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.