DR. JESSE ROBERT PETERSON (DPT) – Physical Therapist, NPI 1104571256

DR. JESSE ROBERT PETERSON (DPT) is a healthcare provider. based in Pueblo, Colorado. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials DPT. They hold a License No. 0018220 (CO). The NPI Number for DR. JESSE ROBERT PETERSON (DPT) is 1104571256

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
DR. JESSE ROBERT PETERSON (DPT)
NPI
1104571256
Phone
(719) 542-4444
Address
3525 E SPAULDING AVE
Enumeration Date
17 February 2022
Last Update Date
17 February 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2084170090
Graduation Year
2021 (5 years ago)
PAC ID
3072909134
Group Practice PAC ID
9234048745
Professional Enrollment ID
I20220926002029
Address ID
ID834044978ID3345XWAYX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:4State licenses:1Digital endpointsOther names

2,986 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CO

Provider Addresses for DR. JESSE ROBERT PETERSON (DPT)

  • 3525 E SPAULDING AVE

    PUEBLO, CO 810082208

    Phone: (719) 542-4444

    Fax: (719) 543-1990

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-09-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220926002029IPhysical Therapist In Private PracticeIDTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes1,12040$0
97140Therapy procedure using manual technique, each 15 minutes78938$0
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care29132$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes6911$0
97163Evaluation for physical therapy, typically 45 minutes1614$0
View full utilization report →

Insurance plans in this area (ZIP 81008)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9234048745View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeUT
Physical Therapist In Private PracticeUT
Physical Therapist In Private PracticeID
Physical Therapist In Private PracticeID
Physical Therapist In Private PracticeIL
Physical Therapist In Private PracticeID
Physical Therapist In Private PracticeID
Physical Therapist In Private PracticeUT
Physical Therapist In Private PracticeUT
Physical Therapist In Private PracticeUT

Reviews

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Frequently asked questions

Where can patients find DR. JESSE ROBERT PETERSON (DPT)'s NPI?
You can confirm DR. JESSE ROBERT PETERSON (DPT) with NPI 1104571256; it appears in the national provider directory.
Is DR. JESSE ROBERT PETERSON (DPT) currently active in the NPI registry?
CMS-published data lists DR. JESSE ROBERT PETERSON (DPT) as an active registrant.
What field does DR. JESSE ROBERT PETERSON (DPT) work in?
You can think of DR. JESSE ROBERT PETERSON (DPT) as practicing within Physical Therapist. Clinical services aligned with this taxonomy classification.
Where does public data place DR. JESSE ROBERT PETERSON (DPT)?
The snapshot lists Pueblo, Colorado for DR. JESSE ROBERT PETERSON (DPT); download NPPES for the complete set.
Is DR. JESSE ROBERT PETERSON (DPT) a real provider?
This page reflects official NPPES data for NPI 1104571256. Always confirm identity and privileges with the practice and licensing boards.

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