Basic Information
| Provider Information | |||||||||
| NPI: | 1508972803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | DWIGHT | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62106 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931602106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056811761 | ||||||||
| FaxNumber: | 8056811768 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 PESETAS LN | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056811761 | ||||||||
| FaxNumber: | 8056811768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT22969 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.