Camille Dimonte Peterson, P.T., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501004807 Issued in MI

Practice address

2383 State Highway 17
Phelps, WI 54554-9472

Phone

(715) 545-3886

Fax

(715) 545-3412

NPI assigned

Sep 11, 2006

Last updated

Apr 28, 2009By 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 2

Addresses

Other identifiers 2

Other names 1

• Dr. Camille Di Monte Peterson Professional name

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240876800000",
    "number": "1407950546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1476 US HIGHWAY 2",
            "city": "CRYSTAL FALLS",
            "state": "MI",
            "postal_code": "499209628",
            "telephone_number": "906-875-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2383 STATE HIGHWAY 17",
            "city": "PHELPS",
            "state": "WI",
            "postal_code": "545549472",
            "telephone_number": "715-545-3886",
            "fax_number": "715-545-3412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CAMILLE",
        "middle_name": "DIMONTE",
        "credential": "P.T., DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2009-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004807",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4377-024",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4673910",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "40203800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAMILLE",
            "last_name": "PETERSON",
            "middle_name": "DI MONTE",
            "prefix": "DR.",
            "credential": "P.T., D.P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Physical Therapist in Phelps, WI
• Providers in Phelps, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; 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.