Bruce E Peterson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00002292 Issued in WA

Practice address

625 9TH Avenue
Suite 220
Longview, WA 98632-2544

Phone

(360) 578-1188

Fax

(360) 578-6251

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Longview Physical and Sports Therapy Services PS

  • Physical Therapist
  • Longview, WA
  • NPI 1184835100
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1306844063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 9TH AVENUE",
            "address_2": "SUITE 220",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322544",
            "telephone_number": "360-578-1188",
            "fax_number": "360-578-6251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 9TH AVENUE",
            "address_2": "SUITE 220",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322544",
            "telephone_number": "360-578-1188",
            "fax_number": "360-578-6251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRUCE",
        "middle_name": "E",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00002292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "932823",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8930118",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "K465803",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANENTE",
            "identifier": "113275",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & IND",
            "identifier": "179681",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8345589",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Lynette Perry, CDP
• Jessica Adrienne Pete
• Peter C Wagner DMD PS
• Richard Petersen
• Lisa Corrine Peterson-Roberts, SLPA
• Patricia J. Peterson, MD
• Lan N Pham, M.D.
• Natasha Phan, RN
• Philip H. Henderson III
• Shawna M Phillipps, LMP

• Physical Therapist in Longview, WA
• Providers in Longview, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.