Provider Demographics
NPI:1750426102
Name:PETERSON, ERIN (DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3029
Mailing Address - Country:US
Mailing Address - Phone:206-447-2220
Mailing Address - Fax:206-447-2228
Practice Address - Street 1:1201 3RD AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3029
Practice Address - Country:US
Practice Address - Phone:206-447-2220
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356411011OtherGROUP NPI NUMBER
WA144285OtherL&I GROUP NUMBER
WA201445OtherL&I INDIVIDUAL NUMBER
WA8400269Medicaid
WA7101066Medicaid
WA8400269Medicaid
WA144285OtherL&I GROUP NUMBER