Individual
DONALD PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1503 WASHINGTON LN, AUGUSTA, KS 67010-1638
(316) 775-0700
(316) 775-0730
Mailing address
1257 KS 99 HWY, EUREKA, KS 67045
(620) 583-7717
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1102114
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140880
BLUE CROSS BLUE SHIELD
KS
01
—
14295
PERFERRED PLUS OF KANSAS
KS
Enumeration date
08/31/2005
Last updated
07/08/2007
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