Active NPI
Jenele Peterson, DPT
- Orthopedic Physical Therapist
- Novato, CA
National Provider Identifier
1154876902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PT291875
- Practice address
- 88 Rowland Way
Suite 250
Novato, CA 94945-5042 - Phone
- (415) 898-1311
- Fax
- (415) 897-0741
- NPI assigned
- Aug 22, 2016
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PT291875 | CA | Primary |
Addresses
Primary practice location
88 Rowland Way
Suite 250
Novato, CA 94945-5042
Mailing address
PO Box 950
Novato, CA 94948-0950
Phone (415) 898-1311
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT291875 | CA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479859200000",
"number": "1154876902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 950",
"city": "NOVATO",
"state": "CA",
"postal_code": "949480950",
"telephone_number": "415-898-1311",
"fax_number": "415-897-0741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "88 ROWLAND WAY",
"address_2": "SUITE 250",
"city": "NOVATO",
"state": "CA",
"postal_code": "949455042",
"telephone_number": "415-898-1311",
"fax_number": "415-897-0741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JENELE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-22",
"last_updated": "2016-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "CA",
"license": "PT291875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.