| Grant Peterson, | |
|
5430 Boone Ave N, New Hope, MN 55428-3615 | |
| (763) 592-2774 | |
| Not Available |
| Full Name | Grant Peterson |
|---|---|
| Gender | Male |
| Speciality | Speech-language Pathologist |
| Location | 5430 Boone Ave N, New Hope, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366283046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 235Z00000X | Speech-language Pathologist | 9877 (Minnesota) | Primary |
| Provider Name | Powerback Rehabilitation Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1013498914 PECOS PAC ID: 2365359932 Enrollment ID: O20181204002105 |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Peterson, 5430 Boone Ave N, New Hope, MN 55428 Ph: (320) 292-6200 | Grant Peterson, 5430 Boone Ave N, New Hope, MN 55428-3615 Ph: (763) 592-2774 |
Sara Stewart, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 4900 Highway 169 N Ste 100, New Hope, MN 55428 Phone: 952-807-5682 | |
Claire Pauline Slayter, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 9220 Bass Lake Rd, New Hope, MN 55428 Phone: 612-273-6228 | |
Nicole Lampi, SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 9220 Bass Lake Rd, Suite 260, New Hope, MN 55428 Phone: 763-533-0363 Fax: 763-533-0842 | |
Amanda Rose Jackson, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 5430 Boone Ave N, New Hope, MN 55428 Phone: 763-592-2600 | |
Mrs. Kathryn Ann Mclachlan, CCC SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 4124 Quebec Ave N, Suite 201, New Hope, MN 55427 Phone: 763-537-6957 | |
Kelsey K. Volkmann, CCC-SLP Speech-Language Pathologist Medicare: Medicare Enrolled Practice Location: 9220 Bass Lake Rd Ste 260, New Hope, MN 55428 Phone: 763-533-0363 Fax: 763-533-0842 | |
Mrs. Stephanie Ann Mccann, MS, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 8100 Medicine Lake Rd, New Hope, MN 55427 Phone: 920-427-5894 |