Michael Peterson, M.S., ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.002411 Issued in IL

Practice address

620 N Diers Ave
Suite 300
Grand Island, NE 68803-4984

Phone

(308) 382-0344

NPI assigned

Feb 6, 2012

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

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Go Physical Therapy, LLC

  • Physical Therapist
  • Grand Island, NE
  • NPI 1184627911
  NPD (past)

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1285906321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4021 ANNE MARIE AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688039702",
            "telephone_number": "815-712-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N DIERS AVE",
            "address_2": "SUITE 300",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034984",
            "telephone_number": "308-382-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "credential": "M.S., ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-06",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.002411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Peterson, RD, LMNT
• Kelly Andrew Peterson
• Kimberlynn Leanne Peterson
• Lucy Margaret Peterson
• Maxine Peterson
• Shannon Peterson
• Jazmine Petties
• Kolleena Marie Petzoldt
• Christine Pfeifer
• Tracie Fawn Pfeifle, LPN-C

• Athletic Trainer in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Athletic Trainer in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; 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.