Individual
HAZEL DIANE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1590 W FILLMORE ST, COLORADO SPRINGS, CO 80904-1104
(719) 641-2898
Mailing address
6055 NESTER WAY, COLORADO SPRINGS, CO 80922-1853
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0001140
CO
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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