Active NPI
James Edward Petters, PT
- Geriatric Physical Therapist
- Elk River, MN
National Provider Identifier
1629239470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 4410
- Practice address
- 13854 Riverview Drive NW
Elk River, MN 55330-1626 - Phone
- (763) 232-0818
- Fax
- (763) 441-0487
- NPI assigned
- Jun 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 4410 | MN | Primary |
Addresses
Primary practice location
13854 Riverview Drive NW
Elk River, MN 55330-1626
Mailing address
13854 Riverview Drive NW
Elk River, MN 55330-1626
Phone (763) 232-0818
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 |
|---|---|---|---|
| 4410 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1629239470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13854 RIVERVIEW DRIVE NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301626",
"telephone_number": "763-232-0818",
"fax_number": "763-441-0487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13854 RIVERVIEW DRIVE NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301626",
"telephone_number": "763-232-0818",
"fax_number": "763-441-0487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERS",
"first_name": "JAMES",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-24",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "MN",
"license": "4410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.