Provider Demographics
NPI:1740666551
Name:PETERS, ERIC (PTA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4024
Mailing Address - Country:US
Mailing Address - Phone:614-747-1184
Mailing Address - Fax:
Practice Address - Street 1:6499 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6505
Practice Address - Country:US
Practice Address - Phone:614-355-9760
Practice Address - Fax:614-355-9765
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07628225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant