Individual
CRAIG M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
203 E DALKE AVE, SPOKANE, WA 99208-8112
(509) 483-8228
(509) 483-8338
Mailing address
203 E DALKE AVE, SPOKANE, WA 99208-8112
(509) 483-8228
(509) 483-8338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005023
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB3601
RR MEDICARE GROUP #
WA
01
—
G8800296
MEDICARE GROUP NUMBER
WA
01
—
P00099837
RR MEDICARE
WA
Enumeration date
12/05/2006
Last updated
11/15/2013
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