Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7743 | MN |
N | 2251S0007X | Physical Therapist - Sports | 7743 | MN |
NPI | 1245279306 |
---|---|
Provider Name | Peter S. Ames |
First Address | Oakdale, MN 55128-6635 |
Second Address | Minnetonka, MN 55345-5984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 11/08/2021 |