Paul Arthur Peterson, A.T.,C.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126000133 Issued in VA

Practice address

46400 Algonkian Pkwy
Potomac Falls, VA 20165-6487

Phone

(703) 444-7542

Fax

(703) 444-7552

NPI assigned

Mar 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285752642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W COUNTRY CLUB DR",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201323042",
            "telephone_number": "540-751-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46400 ALGONKIAN PKWY",
            "city": "POTOMAC FALLS",
            "state": "VA",
            "postal_code": "201656487",
            "telephone_number": "703-444-7542",
            "fax_number": "703-444-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAUL",
        "middle_name": "ARTHUR",
        "name_prefix": "Mr.",
        "credential": "A.T.,C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126000133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Potomac Falls, VA
• Providers in Potomac Falls, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.