Individual provider Active NPI

Kristina Peterson, PT

  • Physical Therapist
  • University Place, WA
National Provider Identifier
1417431354
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60850749 Issued in WA
Practice address
7727 40TH St W Ste a
University Place, WA 98466-3146
Phone
(253) 460-1362
Fax
(253) 460-6628
NPI assigned
Sep 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60850749 WA Primary

Addresses

Primary practice location

7727 40TH St W Ste a
University Place, WA 98466-3146

Mailing address

6050 Tacoma Mall Blvd Ste 300
Tacoma, WA 98409-6828
Phone (253) 581-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210730002115 CA Practitioner - Physical Medicine and Rehabilitation 5496099897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Physical Therapy and FitnessGroup PAC ID 9234435215, 11 clinicians

Practice addresses (Care Compare)

8030 Soquel Ave
Suite 200
Santa Cruz, CA 95062-2096
Phone (831) 464-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Precision Physical Therapy & Fitness Physical Therapist CurrentSince Apr 27, 2021 Accepting new patients
Multicare Health System Physical Therapist Past Accepting new patients

Locations

8030 Soquel Ave
Ste 200
Santa Cruz, CA 95062
Phone (831) 464-8200

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537142400000",
    "number": "1417431354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 TACOMA MALL BLVD STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984096828",
            "telephone_number": "253-581-5200",
            "fax_number": "253-581-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 40TH ST W STE A",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984663146",
            "telephone_number": "253-460-1362",
            "fax_number": "253-460-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KRISTINA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-17",
        "last_updated": "2018-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60850749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

Verify at the official NPI Registry.