Provider Demographics
NPI:1780111682
Name:PETERSON, ERIC CHRISTOPHER (RRT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:PETERSON
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10032 E BASS CIR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-5449
Mailing Address - Country:US
Mailing Address - Phone:352-423-4014
Mailing Address - Fax:
Practice Address - Street 1:2435 US HIGHWAY 19 STE 300
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3909
Practice Address - Country:US
Practice Address - Phone:352-400-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT127552279H0200X, 227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health