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Individual
MR. BART C PETERSON
Active
Individual
MR. BART C PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0060
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060
STATE LICENSE NUMBER
AZ
Enumeration date
07/20/2006
Last updated
07/08/2007
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