Active NPI
Craig M Peterson, PT
- Physical Therapist
- Spokane, WA
National Provider Identifier
1871651174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00005023
- Practice address
- 203 E Dalke Ave
Spokane, WA 99208-8112 - Phone
- (509) 483-8228
- Fax
- (509) 483-8338
- NPI assigned
- Dec 5, 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 | PT00005023 | WA | Primary |
Addresses
Primary practice location
203 E Dalke Ave
Spokane, WA 99208-8112
Mailing address
203 E Dalke Ave
Spokane, WA 99208-8112
Phone (509) 483-8228
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00099837 | Other | WA | RR MEDICARE |
| G8800296 | Other | WA | MEDICARE GROUP NUMBER |
| DB3601 | Other | WA | RR MEDICARE GROUP # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1871651174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 E DALKE AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992088112",
"telephone_number": "509-483-8228",
"fax_number": "509-483-8338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 E DALKE AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992088112",
"telephone_number": "509-483-8228",
"fax_number": "509-483-8338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CRAIG",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00005023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00099837",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "G8800296",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP #",
"identifier": "DB3601",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.