Individual
NATHANIEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
126 W SAINT CLAIR ST, ROMEO, MI 48065-4654
(586) 651-4712
Mailing address
11973 SPRINGBROOK CT, BRUCE TWP, MI 48065-3867
(586) 651-4712
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501004865
MI
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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