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General NPI Number Information
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NPI Number | 1285752642
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Entity Type | Individual
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Provider Name | PAUL ARTHUR PETERSON A.T.,C.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 46400 ALGONKIAN PKWY
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-6487
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Country | US
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Telephone | 703-444-7542
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Fax | 703-444-7552
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Provider Business Mailing Address
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Address Line | 640 W COUNTRY CLUB DR
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City | PURCELLVILLE
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State | VA
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Zip | 20132-3042
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Country | US
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Telephone | 540-751-1717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000133
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License Number State | VA
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