Doctor Name: | KEVIN PETERSON |
NPI Number: | 1538533393 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 004782 |
Business Practice Address: | 1239 73rd St Suite J Windsor Heights, IA - 503241339 |
Business Phone Number: | 5158299477 |
Business Fax Number: | |
Mailing Address: | 5641 Vista Dr, WEST DES MOINES |
State: | IA |
Postal Code: | 502667581 |
Phone Number: | 5158299477 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2015 |
NPI Last Update Date: | 11/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 004782 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |