Active NPI
Jon Petkers
- Physical Therapist
- Auburn, ME
National Provider Identifier
1841369659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 690 Minot Ave Ste 2
Auburn, ME 04210-3922 - Phone
- (207) 783-3450
- NPI assigned
- Nov 7, 2006
- 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 | Primary |
Addresses
Primary practice location
690 Minot Ave Ste 2
Auburn, ME 04210-3922
Mailing address
16 Upland Rd
Lisbon, ME 04250-6805
Phone (207) 333-1863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2735 | Other | ME | 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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841369659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 UPLAND RD",
"city": "LISBON",
"state": "ME",
"postal_code": "042506805",
"telephone_number": "207-333-1863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "690 MINOT AVE STE 2",
"city": "AUBURN",
"state": "ME",
"postal_code": "042103922",
"telephone_number": "207-783-3450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETKERS",
"first_name": "JON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "2735",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.