Active NPI
Glenn Peterson, PTA
- Developmental Therapist
- Brownsville, TX
National Provider Identifier
1295083699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 2088488
- Practice address
- 871 Old Alice Rd
Suite 600
Brownsville, TX 78520-8268 - Phone
- (615) 714-8177
- NPI assigned
- Aug 16, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 2088488 | TX | Primary |
Addresses
Primary practice location
871 Old Alice Rd
Suite 600
Brownsville, TX 78520-8268
Mailing address
871 Old Alice Rd
Suite 600
Brownsville, TX 78520-8268
Phone (615) 714-8177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2088488 | Other | TX | STATE LICENSE NUMBER |
| 2088488 | Other | TX | STATE LICENCE NUMBER |
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 |
|---|---|---|---|
| 2088488 | TX | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1295083699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "871 OLD ALICE RD",
"address_2": "SUITE 600",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785208268",
"telephone_number": "615-714-8177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 OLD ALICE RD",
"address_2": "SUITE 600",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785208268",
"telephone_number": "615-714-8177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GLENN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-16",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "TX",
"license": "2088488",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "2088488",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENCE NUMBER",
"identifier": "2088488",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brownsville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.