Active NPI
Dane Peterson, PT
- Physical Therapist
- Renton, WA
National Provider Identifier
1700250735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT60599956
- Practice address
- 14028 SE Petrovitsky Rd
Renton, WA 98058-8933 - Phone
- (425) 272-0252
- Fax
- (425) 272-0291
- NPI assigned
- Nov 13, 2015
- Last updated
- Feb 25, 2016
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | PT60599956 | WA | Primary |
Addresses
Primary practice location
14028 SE Petrovitsky Rd
Renton, WA 98058-8933
Mailing address
16083 SW Upper Boones Ferry Rd
Suite 300
Tigard, OR 97224-7736
Phone (503) 443-6156
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0349712 | Other | WA | WA L&I |
| 1700250735 | Medicaid | WA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT60599956 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba TAI Fairwood Physical Therapy
- Physical Therapist
- Renton, WA
- NPI 1629054465
-
dba TAI Cedar Hills Physical Therapy
- Physical Therapist
- Portland, OR
- NPI 1700862000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1700250735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16083 SW UPPER BOONES FERRY RD",
"address_2": "SUITE 300",
"city": "TIGARD",
"state": "OR",
"postal_code": "972247736",
"telephone_number": "503-443-6156",
"fax_number": "503-639-9699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14028 SE PETROVITSKY RD",
"city": "RENTON",
"state": "WA",
"postal_code": "980588933",
"telephone_number": "425-272-0252",
"fax_number": "425-272-0291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DANE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-13",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60599956",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA L&I",
"identifier": "0349712",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1700250735",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.