Individual
JEFFREY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
17735 XYLITE ST NE, HAM LAKE, MN 55304-4436
(763) 213-2033
Mailing address
17735 XYLITE ST NE, HAM LAKE, MN 55304-4436
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/28/2014
Last updated
08/28/2014
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