Individual
THOMAS MICHAEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3537 10TH ST S, FARGO, ND 58104-6201
(701) 261-1145
Mailing address
3537 10TH ST S, FARGO, ND 58104-6201
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
01884
ND
Other
Enumeration date
03/24/2006
Last updated
08/15/2014
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