Individual
MITCHELL WAYNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 BLANCA AVE STE 300, ALAMOSA, CO 81101-2340
(719) 589-5149
Mailing address
128 MARKET ST, ALAMOSA, CO 81101-2290
(719) 587-1161
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18605
LICENSE NUMBER
CO
Enumeration date
08/16/2022
Last updated
08/16/2022
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