Wayne E Petereit, LPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-004624 Issued in IL

Practice address

1201 S Main St
Jacksonville, IL 62650-3339

Phone

(217) 479-2300

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1376753335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2127 INNERBELT BUSINESS CENTER DR",
            "address_2": "SUITE 107",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631145700",
            "telephone_number": "314-506-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503339",
            "telephone_number": "217-479-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETEREIT",
        "first_name": "WAYNE",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "LPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-004624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PHYSICAL THERAPI",
            "identifier": "070004624",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Dylan Pate, PA-C
• Mosam B Patel, M.D.
• Pathway Services Unlimited Inc
• Aubrie Laine Patkus, PHARMD
• Peter a Trace, M.D.
• John Andrew Peterson, M.D.
• James Thomas Phillips, D.C.
• Physical Therapists Clinic, LTD
• Physical Therapists Clinic,LTD
• Jane E. Piper, NP

• Physical Therapist in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; 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.