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Individual

KEVIN NICHOLAS PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
980 ROOSEVELT STE 100, IRVINE, CA 92620-3670
(949) 333-6400
Mailing address
2412 E ATHENS AVE, ORANGE, CA 92867-4408
(661) 713-4584

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
297167
CA

Other

Enumeration date
08/14/2019
Last updated
11/27/2023
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