JEFFREY PETERSON (NPI# 1245630177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245630177 |
| Entity Type | Individual |
| Full Name | JEFFREY PETERSON |
| Credential | ATC |
| Practice Address |
17735 Xylite St Ne Ham Lake MN 55304-4436 |
| Practice Telephone | 7632132033 |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2014-08-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205328515 | Jeffrey Michael Peterson | Specialist/Technologist | 15534 Calabria Ct, Bakersfield, CA 93314-8055 | 2018-06-01 |
| 1568981314 | Jeffrey Joseph Peterson | Behavior Technician | 162 N 400 E Ste A-105, St. George, UT 84770 | 2017-09-13 |
| 1578889945 | Jeffrey Peterson | Ophthalmology | 615 Piikoi St Ste 205, Honolulu, HI 96814-3139 | 2010-04-10 |
| 1669689949 | Jeffrey Scott Peterson | Orthopaedic Surgery | 3085 Sparta St, Mcminnville, TN 37110-1364 | 2007-05-17 |
| 1689790917 | Jeffrey Hal Peterson | Chiropractor | 8290 E Broadway Blvd, Tucson, AZ 85710-4006 | 2007-03-21 |
| 1417003567 | Jeffrey Peterson | Psychiatry & Neurology | 2911 E Coronado St, Anaheim, CA 92806 | 2007-01-25 |
| 1740214345 | Jeffrey Scott Peterson | Physical Therapist | 204 S Mckean St, Butler, PA 16001-6012 | 2006-07-10 |
| 1598323271 | Jeffrey Steven Peterson | Anesthesiology | 200 Hawkins Dr Dept Of, Iowa City, IA 52242-1009 | 2019-05-29 |
| 1669608899 | Jeffrey S Peterson | Social Worker | 625 W Washington Ave, Madison, WI 53703-2637 | 2009-06-02 |
| 1497832513 | Jeffrey J Peterson | Emergency Medicine | 345 North Smith Avenue, Childrens Hospitals and Clinics of Minnesota Emergency, St Paul, MN 55102 | 2006-11-01 |
| Street Address |
17735 XYLITE ST NE |
| City | HAM LAKE |
| State | MN |
| Zip Code | 55304-4436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114402211 | Sarah Sue Anderson | Speech-Language Pathologist | 1891 Station Pkwy, Andover, MN 55304 | 2018-09-25 |
| 1306354329 | Jennifer Lynn Larkey I | Counselor | 1875 Station Parkway N.w. Andover, Mn 55304, Andover, MN 55304 | 2018-01-11 |
| 1124544895 | Msp Dentistry Inc | Preferred Provider Organization | 13650 Hanson Blvd., Suite #110, Andover, MN 55304 | 2017-08-15 |
| 1912427931 | Brooke Nicole Halliday | Counselor | 1875 Station Pkwy Ne, Andover, MN 55304 | 2017-06-21 |
| 1700286903 | Jari Welle, Inc. | Marriage & Family Therapist | 1328 Mckay Drive Ne, Suite 100, Ham Lake, MN 55304 | 2014-08-26 |
| 1356765192 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1889 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1326462177 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1899 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1740619568 | Delores Weikle | Physical Therapist | 14531 Jay St, Andover, MN 55304 | 2013-11-02 |
| 1730527003 | Darkou Care Services | Home Health | 14297 Zilla Street Nw, Andover, MN 55304 | 2013-06-10 |
| 1770927758 | Arbor Oaks Senior Living | Assisted Living Facility | 1640 155th Lane Nw, Andover, MN 55304 | 2013-04-22 |
| Find all providers in zip 55304 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467830133 | Karie Francen | Specialist/Technologist | 965 141st Ln Ne, Ham Lake, MN 55304-6760 | 2015-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861092165 | Jamie Lynn Erickson | Specialist/Technologist | 43628 374th Ln, Aitkin, MN 56431-4027 | 2020-10-27 |
| 1760082044 | Craig Daniel Merten | Specialist/Technologist | 5045 Division Ave # 5575, White Bear Lake, MN 55110-2663 | 2020-10-27 |
| 1154928927 | Heidi Frey | Specialist/Technologist | 4554 Lake Park Ct, Eagan, MN 55122-2515 | 2020-10-05 |
| 1851906887 | Teddy Ray Gildersleeve | Specialist/Technologist | 37320 Oriole Ave, Lindstrom, MN 55045-9109 | 2020-09-15 |
| 1851906697 | Tadd William Berg | Specialist/Technologist | 2415 W 9th St, Duluth, MN 55806-1150 | 2020-09-09 |
| 1952916793 | Megan Marie Hautajarvi | Specialist/Technologist | 2536 Peace Dr, Duluth, MN 55811-2971 | 2020-09-09 |
| 1871108795 | Bryce Mershon Beamish | Specialist/Technologist | 3501 Lowell St, Wayzata, MN 55391-3411 | 2020-09-09 |
| 1043825961 | Kevin Eskuri | Specialist/Technologist | 8090 172nd St W, Lakeville, MN 55044-6206 | 2020-09-09 |
| 1952916876 | Elizabeth Marie Altendorf | Specialist/Technologist | 1621 397th Ave Ne, Stanchfield, MN 55080-3303 | 2020-09-09 |
| 1699380519 | Kourtney Jean Palmi | Specialist/Technologist | 4922 Howard Gnesen Rd, Duluth, MN 55803-2710 | 2020-09-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.