Provider Demographics
NPI:1154755965
Name:PETERSON, SETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 E VISTOSO COMMERCE LOOP STE 180
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-9123
Mailing Address - Country:US
Mailing Address - Phone:520-389-5311
Mailing Address - Fax:
Practice Address - Street 1:2512 E VISTOSO COMMERCE LOOP
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9123
Practice Address - Country:US
Practice Address - Phone:520-389-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist