Individual
COLLIN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3720 LACLEDE AVE, SAINT LOUIS, MO 63108-3300
(818) 438-9218
Mailing address
9803 CRAIG MITCHELL LN, SHADOW HILLS, CA 91040-1634
(818) 438-9218
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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