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General NPI Number Information
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NPI Number | 1811953342
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Entity Type | Individual
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Provider Name | CONNIE LEE PETERSON ATC, PHD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | JAMES MADISON UNIVERSITY MSC 4301
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City | HARRISONBURG
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State | VA
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Zip | 22807-0001
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Country | US
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Telephone | 540-568-7085
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Fax | 540-568-3336
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Provider Business Mailing Address
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Address Line | 3839 MILL RACE CT
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City | HARRISONBURG
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State | VA
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Zip | 22801-2270
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Country | US
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Telephone | 540-568-7085
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Fax | 540-568-3336
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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 | 0126000622
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License Number State | VA
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