Active NPI
Mary Kathryn Peterson, MPT
- Geriatric Physical Therapist
- Riverside, CA
National Provider Identifier
1598179434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 23596
- Practice address
- 4690 Whipple Rd
Riverside, CA 92506-1066 - Phone
- (951) 682-3341
- NPI assigned
- Jun 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 23596 | CA | Primary |
| Pediatric Physical Therapist | 2251P0200X | 23596 | CA |
Addresses
Primary practice location
4690 Whipple Rd
Riverside, CA 92506-1066
Mailing address
4690 Whipple Rd
Riverside, CA 92506-1066
Phone (951) 682-3341
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 |
|---|---|---|---|
| 23596 | CA | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403049600000",
"number": "1598179434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4690 WHIPPLE RD",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925061066",
"telephone_number": "951-682-3341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4690 WHIPPLE RD",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925061066",
"telephone_number": "951-682-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MARY",
"middle_name": "KATHRYN",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-18",
"last_updated": "2014-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "CA",
"license": "23596",
"primary": true
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "23596",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.