Active NPI
Jason Lee Peterson, PHYSICAL THERAPIST
- Physical Therapy Assistant
- The Woodlands, TX
National Provider Identifier
1689173056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2133563
- Practice address
- 10857 Kuykendahl Rd Ste 120
The Woodlands, TX 77382-2936 - Phone
- (815) 218-1402
- NPI assigned
- Feb 12, 2018
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2133563 | TX | Primary |
Addresses
Primary practice location
10857 Kuykendahl Rd Ste 120
The Woodlands, TX 77382-2936
Mailing address
10857 Kuykendahl Rd Ste 120
The Woodlands, TX 77382-2936
Phone (936) 256-3883
Other practice location 1
10123 Louetta Rd # B200
Houston, TX 77070-2160
Phone (936) 256-3883
Other practice location 2
500 Medical Center Blvd Ste 200
Conroe, TX 77304-2800
Phone (936) 256-3883
Other practice location 3
129 Vision Park Blvd Ste 306
Shenandoah, TX 77384-3024
Phone (936) 256-3883
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 |
|---|---|---|---|
| 2133563 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1689173056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10857 KUYKENDAHL RD STE 120",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773822936",
"telephone_number": "936-256-3883",
"fax_number": "936-398-6095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10857 KUYKENDAHL RD STE 120",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773822936",
"telephone_number": "815-218-1402"
}
],
"practiceLocations": [
{
"address_1": "10123 Louetta Rd # B200",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770702160",
"country_code": "US",
"telephone_number": "936-256-3883",
"fax_number": "936-398-6095",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "500 Medical Center Blvd Ste 200",
"address_purpose": "LOCATION",
"city": "Conroe",
"state": "TX",
"postal_code": "773042800",
"country_code": "US",
"telephone_number": "936-256-3883",
"fax_number": "936-398-6095",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "129 Vision Park Blvd Ste 306",
"address_purpose": "LOCATION",
"city": "Shenandoah",
"state": "TX",
"postal_code": "773843024",
"country_code": "US",
"telephone_number": "936-256-3883",
"fax_number": "936-398-6095",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "JASON",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-02-12",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2133563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in The Woodlands, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.