Hazel Diane Peterson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT.0001140 Issued in CO

Practice address

1590 W Fillmore St
Colorado Springs, CO 80904-1104

Phone

(719) 641-2898

NPI assigned

Nov 29, 2017

Last updated

Nov 29, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Hazel Diane Reyes Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1144734013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6055 NESTER WAY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809221853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 W FILLMORE ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809041104",
            "telephone_number": "719-641-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "HAZEL",
        "middle_name": "DIANE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-29",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CO",
            "license": "AT.0001140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HAZEL",
            "last_name": "REYES",
            "middle_name": "DIANE",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Benjamin Peterson
• Daniel M Peterson, MD
• Darah Elizabeth Peterson
• Eric L Peterson, MSW
• Gabrielle Peterson
• Jeremy Peterson, LPC
• Kayla Peterson, NP
• Kristin Peterson, PA-C
• Kyle Peterson, RBT
• Laura Peterson

• Athletic Trainer in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Athletic Trainer in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.