Individual ProviderJennifer Kay PetersonPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address11671 Fountains Dr, Suite 220, Maple Grove, MN 55369-4711(763) 420-2767PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Kay Peterson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1871680454Provider TypeIndividualFull NamePeterson, Jennifer KayCredentialPTGenderFemaleSole ProprietorNoEnumeration Date10/6/2006Last Updated3/17/2015Contact InformationPractice LocationPractice Address11671 Fountains Dr, Suite 220, Maple Grove, MN 55369-4711Phone(763) 420-2767FaxUnlisted FaxMailing LocationMailing Address11671 Fountains Dr, Suite 220, Maple Grove, MN 55369-4711Phone(763) 420-2767FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense5150Minnesota