Provider Demographics
NPI:1073227807
Name:PETERS, RAMSAY L
Entity Type:Individual
Prefix:
First Name:RAMSAY
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5235
Mailing Address - Country:US
Mailing Address - Phone:208-805-2097
Mailing Address - Fax:
Practice Address - Street 1:1360 E FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5235
Practice Address - Country:US
Practice Address - Phone:208-805-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer