Individual
MR. BART C PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1302 S AVENIDA VEGA, TUCSON, AZ 85710-5101
(520) 584-7400
Mailing address
7687 S LIONS SPRING WAY, TUCSON, AZ 85747-5650
(520) 574-2059
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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