Individual
MATHEW JAMES PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
10214 MUSICK RD, SAINT LOUIS, MO 63123-5066
(314) 882-7043
Mailing address
10214 MUSICK RD, SAINT LOUIS, MO 63123-5066
(314) 882-7043
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2012022607
MO
Other
Enumeration date
11/21/2014
Last updated
11/21/2014
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