Active NPI
Christine Jo Peterson, MPT
- Physical Therapist
- Superior, WI
National Provider Identifier
1932325172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4841-024
- Practice address
- 1800 New York Ave
Superior, WI 54880-2008 - Phone
- (715) 394-5591
- NPI assigned
- Apr 17, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4841-024 | WI | Primary |
Addresses
Primary practice location
1800 New York Ave
Superior, WI 54880-2008
Mailing address
2114 Hammond Ave
Superior, WI 54880-5038
Phone (715) 394-9384
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 |
|---|---|---|---|
| 4841-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932325172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2114 HAMMOND AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805038",
"telephone_number": "715-394-9384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 NEW YORK AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548802008",
"telephone_number": "715-394-5591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CHRISTINE",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4841-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Superior, WI
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.