Active NPI
Susan Adele Petersen, LMT
- Mechanotherapist
- Wilsonville, OR
National Provider Identifier
1801061676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 10903
- Practice address
- 30240 SW Parkway Ave Ste 5
Wilsonville, OR 97070-9756 - Phone
- (503) 730-1785
- NPI assigned
- Apr 23, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 10903 | OR | Primary |
Addresses
Primary practice location
30240 SW Parkway Ave Ste 5
Wilsonville, OR 97070-9756
Mailing address
30240 SW Parkway Ave Ste 5
Wilsonville, OR 97070-9756
Phone (503) 730-1785
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 |
|---|---|---|---|
| 10903 | OR | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208908800000",
"number": "1801061676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30240 SW PARKWAY AVE STE 5",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709756",
"telephone_number": "503-730-1785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30240 SW PARKWAY AVE STE 5",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709756",
"telephone_number": "503-730-1785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "SUSAN",
"middle_name": "ADELE",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-23",
"last_updated": "2008-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "OR",
"license": "10903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilsonville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.