Provider Demographics
NPI:1902545445
Name:PETERSON, LANDON RANDY (DPT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:RANDY
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 S WADSWORTH BLVD STE A-2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5026
Mailing Address - Country:US
Mailing Address - Phone:303-993-4438
Mailing Address - Fax:303-993-4817
Practice Address - Street 1:1739 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7141
Practice Address - Country:US
Practice Address - Phone:435-634-6080
Practice Address - Fax:435-634-6081
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18405225100000X
UT13613751-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist