Provider Demographics
NPI:1689002917
Name:PETERSON, CHRISTIAN WILLIAM (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:WILLIAM
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1314
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927
Mailing Address - Country:US
Mailing Address - Phone:530-891-8220
Mailing Address - Fax:530-891-8226
Practice Address - Street 1:125 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-891-8220
Practice Address - Fax:530-891-8226
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 40532225100000X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist