Individual
DR. TRAVIS RUSSELL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
59 N ENGLISH RD, VINEYARD, UT 84058-5645
(801) 946-7514
Mailing address
59 N ENGLISH RD, VINEYARD, UT 84058-5645
(801) 946-7514
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9633315-2401
UT
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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