Individual
TODD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, PTA
Contact information
Practice address
120 ERIE CANAL DR, ROCHESTER, NY 14626-4607
(585) 225-6296
Mailing address
P.O. BOX 195, EAST PEMBROKE, NY 14056
(585) 762-8883
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
003649-1
NY
2255A2300X
Athletic Trainer
Primary
001176-1
NY
Other
Enumeration date
02/14/2007
Last updated
09/11/2025
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