Provider Demographics
NPI:1477077527
Name:TRUJILLO, PETER JAMES JR (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:TRUJILLO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CHARNELTON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3906
Mailing Address - Country:US
Mailing Address - Phone:541-762-1755
Mailing Address - Fax:541-638-0068
Practice Address - Street 1:106 W 3RD ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8648
Practice Address - Country:US
Practice Address - Phone:816-786-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61825225100000X
MO2015039543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist