Provider Demographics
NPI:1215030119
Name:PETERS, CHRISTOPHER WARREN (MED ATC LAT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WARREN
Last Name:PETERS
Suffix:
Gender:M
Credentials:MED ATC LAT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED ATC LAT
Mailing Address - Street 1:4112 52ND STREET CT W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-6758
Mailing Address - Country:US
Mailing Address - Phone:941-714-7300
Mailing Address - Fax:941-741-3443
Practice Address - Street 1:902 33RD ST. CT. WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON,
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-714-7300
Practice Address - Fax:941-741-3443
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 19182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer