Individual
JACOB PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1475 ENGINEERING DR, MADISON, WI 53706-1607
(608) 264-8065
Mailing address
1815 UNIVERSITY AVE APT 200, MADISON, WI 53726-4092
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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