Individual
MR. JEFFREY W. PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
308 S 3RD ST, WATSEKA, IL 60970-1604
(815) 432-1005
Mailing address
308 S 3RD ST, WATSEKA, IL 60970-1604
(815) 432-1005
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096001426
IL
Other
Enumeration date
04/06/2009
Last updated
04/06/2009
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