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Individual
TODD PETERSON
Active
Individual
TODD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
003649-1
NY
2255A2300X
Athletic Trainer
Primary
001176-1
NY
Other
Enumeration date
02/14/2007
Last updated
09/11/2025
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