Noah Paul Petersen I, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

109205 Issued in IA

Practice address

800 N 8TH St
Clear Lake, IA 50428-1539

Phone

(641) 456-6910

Fax

(641) 357-0021

NPI assigned

Oct 26, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Molencamp Physical Therapy and Wellness

  • Physical Therapist
  • Clear Lake, IA
  • NPI 1528667029
  NPD

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

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1447977707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N 8TH ST",
            "city": "CLEAR LAKE",
            "state": "IA",
            "postal_code": "504281539",
            "telephone_number": "641-456-6910",
            "fax_number": "641-357-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N 8TH ST",
            "city": "CLEAR LAKE",
            "state": "IA",
            "postal_code": "504281539",
            "telephone_number": "641-456-6910",
            "fax_number": "641-357-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "NOAH",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-26",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IA",
            "license": "109205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Clear Lake, IA
• Providers in Clear Lake, IA by specialty
• Massage Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; 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.