Travis Russell Peterson
Individual provider Active NPI Physical Therapist · Vineyard, UT
NPI 1962859074 · NPPES record last updated May 18, 2016
Key facts
- NPI
- 1962859074
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9633315-2401 (UT)
- Practice address
- 59 N English Rd
Vineyard, UT 84058-5645 - Phone
- (801) 946-7514
- NPI assigned
- May 18, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9633315-2401 | UT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9633315-2401 | UT | Yes |
Addresses
Primary practice location
59 N English Rd
Vineyard, UT 84058-5645
Mailing address
59 N English Rd
Vineyard, UT 84058-5645
Phone (801) 946-7514
Other providers in Vineyard, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.