Individual
MR. RICKY L PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1701 48TH STREET, SUITE 120, WEST DES MOINES, IA 50266-6723
(515) 224-1474
(515) 224-1478
Mailing address
1701 48TH ST, SUITE 120, WEST DES MOINES, IA 50266-6723
(515) 224-1474
(515) 224-1478
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01473
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0285478
—
IA
01
—
33194
BCBS
IA
Enumeration date
01/18/2006
Last updated
06/04/2008
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