Individual
IAN B PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC-L
Contact information
Practice address
345 TAFT ROAD, SOUTH HOLLAND, IL 60473
(708) 596-0107
(708) 671-0767
Mailing address
14720 CENTRAL AVE, OAK FOREST, IL 60452-1268
(219) 617-5253
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
02/13/2006
Last updated
11/26/2007
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