Active NPI
Meredith Peterson
- Specialist
- Pueblo, CO
National Provider Identifier
1245636810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 16360
- Practice address
- 3902 Sandalwood LN
Suite 140
Pueblo, CO 81005-7501 - Phone
- (719) 248-9797
- NPI assigned
- Nov 10, 2014
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 16360 | CO | Primary |
Addresses
Primary practice location
3902 Sandalwood LN
Suite 140
Pueblo, CO 81005-7501
Mailing address
3902 Sandalwood LN
Suite 140
Pueblo, CO 81005-7501
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16360 | CO | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rose Massage Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Massage Therapist
- Pueblo, CO
- NPI 1396563011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415577600000",
"number": "1245636810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3902 SANDALWOOD LN",
"address_2": "SUITE 140",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810057501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3902 SANDALWOOD LN",
"address_2": "SUITE 140",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810057501",
"telephone_number": "719-248-9797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MEREDITH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-10",
"last_updated": "2014-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CO",
"license": "16360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.