Provider Demographics
NPI:1356692974
Name:PEIKERT, JARETT RYAN WILLIAM (ATC)
Entity type:Individual
Prefix:
First Name:JARETT
Middle Name:RYAN WILLIAM
Last Name:PEIKERT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14751 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8744
Mailing Address - Country:US
Mailing Address - Phone:612-227-6316
Mailing Address - Fax:
Practice Address - Street 1:14751 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-8744
Practice Address - Country:US
Practice Address - Phone:612-227-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND400-102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer