Provider Demographics
NPI:1720315609
Name:PETERSON, ERIC CHARLES GONZALES (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHARLES GONZALES
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:CHARLES GONZALES
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:143 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3337
Mailing Address - Country:US
Mailing Address - Phone:831-422-4782
Mailing Address - Fax:
Practice Address - Street 1:143 JOHN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3337
Practice Address - Country:US
Practice Address - Phone:831-422-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist