Provider Demographics
NPI:1346277035
Name:PETERSON, VICTOR M (RPT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 ELKAHATCHEE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4800
Mailing Address - Country:US
Mailing Address - Phone:256-234-0592
Mailing Address - Fax:256-234-7014
Practice Address - Street 1:1784 ELKAHATCHEE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4800
Practice Address - Country:US
Practice Address - Phone:256-234-0592
Practice Address - Fax:256-234-7014
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-28766OtherBCBS OF ALABAMA
AL#77553OtherUPIN