Individual
JOHN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
625 STEVENS ST, MEDFORD, OR 97504-6719
(541) 779-3551
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
09025
OR
225200000X
Physical Therapy Assistant
Primary
PTA24092
FL
Other
Enumeration date
04/25/2014
Last updated
04/25/2014
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