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General NPI Number Information
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NPI Number | 1356811608
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Entity Type | Individual
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Provider Name | MS. CAITLIN MARIE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 15708 WOOD KNOLL LANE
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City | MINNETONKA
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State | MN
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Zip | 55345
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Country | US
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Telephone | 952-412-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WEST COLLEGE AVE
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City | ST. PETER
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State | MN
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Zip | 55345
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Country | US
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Telephone | 952-412-5245
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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 |
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License Number State |
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