# PETERSON PT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peterson Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669480968
- **Authorized official:** BREK LAMONT PETERSON (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (928) 771-2977

## Contact information

- **Practice address:** 1320 W IRON SPRINGS RD, PRESCOTT, AZ 86305-1414
- **Practice address phone:** (928) 771-2977
- **Practice address fax:** (928) 771-2987
- **Mailing address:** 1320 W IRON SPRINGS RD, PRESCOTT, AZ 86305-1414
- **Mailing address phone:** (928) 771-2977
- **Mailing address fax:** (928) 771-2987

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | 5079 | AZ | Yes |
| 2080S0010X | Pediatric Sports Medicine Physician | 5810 | AZ | — |
| 2080S0010X | Pediatric Sports Medicine Physician | 6499 | AZ | — |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 05/20/2024