Active NPI
Ryan Lee Peterson, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1528303641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 39649
- Practice address
- 8650 Genesee Ave
Suite 314
San Diego, CA 92122-1134 - Phone
- (858) 622-9266
- Fax
- (858) 622-0513
- NPI assigned
- Nov 29, 2012
- 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 | 39649 | CA | Primary |
Addresses
Primary practice location
8650 Genesee Ave
Suite 314
San Diego, CA 92122-1134
Mailing address
613 Fern GLN
La Jolla, CA 92037-5419
Phone (805) 801-1869
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 |
|---|---|---|---|
| 39649 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354147200000",
"number": "1528303641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 FERN GLN",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920375419",
"telephone_number": "805-801-1869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8650 GENESEE AVE",
"address_2": "SUITE 314",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921221134",
"telephone_number": "858-622-9266",
"fax_number": "858-622-0513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "RYAN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-29",
"last_updated": "2012-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "39649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.