Active NPI
Stephanie Leigh Peterson, DPT, OTR, ATC
- Physical Therapist
- Simpsonville, SC
National Provider Identifier
1821514860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9750
- Practice address
- 1029 Powderhorn Rd
Simpsonville, SC 29681-3379 - Phone
- (843) 670-7643
- NPI assigned
- Aug 22, 2017
- Last updated
- Nov 9, 2020
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9750 | SC | Primary |
| Athletic Trainer | 2255A2300X | 3689 | FL | |
| Occupational Therapist | 225X00000X | 17596 | FL | |
| Occupational Therapist | 225X00000X | 5988 | SC |
Addresses
Primary practice location
1029 Powderhorn Rd
Simpsonville, SC 29681-3379
Mailing address
1029 Powderhorn Rd
Simpsonville, SC 29681-3379
Phone (843) 670-7643
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5988 | Other | SC | OCCUPATIONAL THERAPY LICENSE |
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 |
|---|---|---|---|
| 3689 | FL | MD | Marriage & Family Therapist |
| 9750 | SC | MD | Nutritionist |
| 17596 | FL | MD | Occupational Therapist |
| 5988 | SC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1821514860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1029 POWDERHORN RD",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296813379",
"telephone_number": "843-670-7643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1029 POWDERHORN RD",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296813379",
"telephone_number": "843-670-7643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "STEPHANIE",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "DPT, OTR, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-22",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "9750",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "3689",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "17596",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "5988",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OCCUPATIONAL THERAPY LICENSE",
"identifier": "5988",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.