Active NPI
Gary G Peterson, PHYSICAL THERAPIST
- Physical Therapist
- Niceville, FL
National Provider Identifier
1447557616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT2579
- Practice address
- 4461 Woodbridge Rd
Niceville, FL 32578-2387 - Phone
- (850) 729-2709
- NPI assigned
- Feb 23, 2011
- Last updated
- Feb 23, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2579 | FL | Primary |
Addresses
Primary practice location
4461 Woodbridge Rd
Niceville, FL 32578-2387
Mailing address
4461 Woodbridge Rd
Niceville, FL 32578-2387
Phone (850) 729-2709
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 |
|---|---|---|---|
| PT2579 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crestview Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
| White Sands Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Crestview, FL
- NPI 1295784668
-
- Physical Therapy Clinic/Center
- Fort Walton Beach, FL
- NPI 1780652941
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298419200000",
"number": "1447557616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4461 WOODBRIDGE RD",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325782387",
"telephone_number": "850-729-2709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4461 WOODBRIDGE RD",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325782387",
"telephone_number": "850-729-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GARY",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-23",
"last_updated": "2011-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT2579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.