Active NPI
Darron Peterson, MPT, MED
- Physical Therapist
- Wasilla, AK
National Provider Identifier
1174613202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1518
- Practice address
- 6341 S. Calista Dr.
Wasilla, AK 99654 - Phone
- (907) 373-0280
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1518 | AK | Primary |
| Physical Therapist | 225100000X | 32803 | CA |
Addresses
Primary practice location
6341 S. Calista Dr.
Wasilla, AK 99654
Mailing address
PO Box 879613
Wasilla, AK 99687-9613
Phone (907) 373-0280
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32803 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174613202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 879613",
"city": "WASILLA",
"state": "AK",
"postal_code": "996879613",
"telephone_number": "907-373-0280",
"fax_number": "907-373-0280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6341 S. CALISTA DR.",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-373-0280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DARRON",
"credential": "MPT, MED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "1518",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "32803",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.