Provider Demographics
NPI:1235858408
Name:PETERS, LEVI (PT,DPT)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 JACKSON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24445-2417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 AMERICAN WAY COURT
Practice Address - Street 2:UNIT C, MAIL BOX #3
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523
Practice Address - Country:US
Practice Address - Phone:540-583-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist