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General NPI Number Information
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NPI Number | 1760878011
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Entity Type | Individual
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Provider Name | CARL PETERSON MBA, ATP
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Gender | Male
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 16820 BARKER SPRINGS RD SUITE E500
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City | HOUSTON
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State | TX
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Zip | 77084-5040
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Country | US
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Telephone | 281-492-2799
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218418
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City | HOUSTON
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State | TX
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Zip | 77218-8418
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Country | US
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Telephone | 281-492-2799
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Fax | 281-492-7479
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | ATP85795
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License Number State | TX
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