Individual
JORDAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9520 PADGETT ST, SAN DIEGO, CA 92126-4445
(858) 866-8133
Mailing address
3544 CAMINITO EL RINCON UNIT 51, SAN DIEGO, CA 92130-2549
(715) 410-4077
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
306141
CA
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
02/07/2020
Last updated
11/18/2024
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