Jan Louise Peterson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 9314 Issued in CA

Practice address

1400 N Dutton Ave
Suite 1
Santa Rosa, CA 95401-4657

Phone

(707) 523-2848

Fax

(707) 523-2866

NPI assigned

Apr 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275759417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N DUTTON AVE",
            "address_2": "SUITE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014643",
            "telephone_number": "707-523-2848",
            "fax_number": "707-523-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N DUTTON AVE",
            "address_2": "SUITE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014657",
            "telephone_number": "707-523-2848",
            "fax_number": "707-523-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JAN",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 9314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Petersen
• Alida Peterson, R.D.
• Carrie Dawn Peterson
• Cole Peterson
• Dylan Peterson, DR.
• Jill Peterson
• Kimberly Peterson, MA, MFTI
• Scott Paul Peterson, M.D.
• Sherrill Diane Petherbridge, FNP
• Parker William Petray

• Physical Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Physical Therapist in California

• 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.

Verify at the official NPI Registry.