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Individual

MEKENNA PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC, SA

Contact information

Practice address
2150 STADIUM DRIVE FLOOR 2, BOULDER, CO 80309-9117
(303) 315-9900
Mailing address
15209 W 48TH AVE, GOLDEN, CO 80403-1722
(563) 580-3756

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0001978
CO
246ZX2200X
Orthopedic Assistant
20-0208
CO
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
11/08/2016
Last updated
09/01/2021
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