Individual
JERICK RICHARD PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1220 HUNTINGTON DR, DUARTE, CA 91010-2477
(626) 359-6618
Mailing address
527 N AZUSA AVE # 179, COVINA, CA 91722-3502
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA48839
CA
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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