Individual
MICHAEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC
Contact information
Practice address
620 N DIERS AVE, SUITE 300, GRAND ISLAND, NE 68803-4984
(308) 382-0344
Mailing address
4021 ANNE MARIE AVE, GRAND ISLAND, NE 68803-9702
(815) 712-7636
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.002411
IL
Other
Enumeration date
02/06/2012
Last updated
07/11/2014
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