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Individual
THOMAS M PETERSON
Active
Individual
THOMAS M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2049
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1D114PE
BLUE CROSS BLUE SHIELD
MN
01
—
6428763
MEDICA AND SELECT CARE
MN
01
—
650022803
RAILROAD MEDICARE
MN
05
—
982345000
—
MN
01
—
HP 24500
HEALTH PARTNERS
MN
Enumeration date
10/11/2006
Last updated
05/02/2023
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