Lars Petersen, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9742 Issued in MN

Practice address

257 Rivertown Dr
Woodbury, MN 55125-7726

Phone

(651) 528-6461

Fax

(651) 528-6349

NPI assigned

Jul 31, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Therapy Partners IncGroup PAC ID 4486552593, 135 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Therapy Partners, Inc.

  • Multi-Specialty Clinic/Center
  • Saint Paul, MN
  • NPI 1407809494

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Therapy Partners Inc

  • Physical Therapist
  • Forest Lake, MN
  • NPI 1821179607
  NPD
• Viverant, LLC

  • Physical Therapist
  • Oakdale, MN
  • NPI 1760418164
  NPD (past)

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1558779777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7581 9TH ST N STE 100",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551286635",
            "telephone_number": "651-748-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 RIVERTOWN DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551257726",
            "telephone_number": "651-528-6461",
            "fax_number": "651-528-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "LARS",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "9742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Kathleen Perryman, A.T.C.
• Renee Jean Persson, PTA
• Mary Perzel, PT
• Sally Nicole Peters, DDS, MS
• Kristy Lynn Petersen, DDS
• Rebecca J Petersen, DDS
• Bradley Peterson
• Christopher Peterson, PHARMD
• Donna Ellena Peterson, MA LP
• Elliana Lein Peterson

• Physical Therapist in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.