Provider Demographics
NPI:1528838349
Name:PETERSON, DEVIN WADE (DPT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:WADE
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24815 US HIGHWAY 281 N STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2629
Mailing Address - Country:US
Mailing Address - Phone:210-868-6640
Mailing Address - Fax:
Practice Address - Street 1:24815 US HIGHWAY 281 N STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2629
Practice Address - Country:US
Practice Address - Phone:210-868-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist