Ricky L Peterson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

01473 Issued in IA

Practice address

1701 48TH Street
Suite 120
West Des Moines, IA 50266-6723

Phone

(515) 224-1474

Fax

(515) 224-1478

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1699755546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 48TH ST",
            "address_2": "SUITE 120",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666723",
            "telephone_number": "515-224-1474",
            "fax_number": "515-224-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 48TH STREET",
            "address_2": "SUITE 120",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666723",
            "telephone_number": "515-224-1474",
            "fax_number": "515-224-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RICKY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "01473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0285478",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "33194",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily J Peterson, PA-C
• Ginni Marie Peterson, PT
• Jordan Dane Peterson, M.D.
• Kelley Ann Peterson, P.A.-C.
• Monica L Peterson, DO
• Queenie Alexina Petit-Frere
• Hasmik Petrosyan
• Jennifer Ruth Bissing Petts, D.O.
• Lehang Pham, DO
• Abigail Kathryn Phelps

• Physical Therapist in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.

Verify at the official NPI Registry.