Individual
MARTIN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
542 16TH ST, RAWLINS, WY 82301-5241
(307) 324-2759
Mailing address
1611 LOCH TAY BLVD, RAWLINS, WY 82301-4144
(307) 324-9561
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
COTA-670
WY
Other
Enumeration date
06/12/2008
Last updated
06/12/2008
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