Provider Demographics
NPI:1942341755
Name:ARTHUR BRADLEY PETERSONPY
Entity Type:Organization
Organization Name:ARTHUR BRADLEY PETERSONPY
Other - Org Name:FERNDALE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-384-5171
Mailing Address - Street 1:PO BOX 1946
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-1946
Mailing Address - Country:US
Mailing Address - Phone:360-384-5171
Mailing Address - Fax:360-384-0350
Practice Address - Street 1:5603 THIRD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-1943
Practice Address - Country:US
Practice Address - Phone:360-384-5171
Practice Address - Fax:360-384-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA038888OtherLABOR & INDUSTRIES
WA7027824Medicaid
WA7027824Medicaid