Sean Wiberg Peterson, MS LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2201-39 Issued in WI

Practice address

1810 Catlin Ave
Room 1246
Superior, WI 54880

Phone

(715) 395-4641

NPI assigned

Dec 6, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1710524970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 E 5TH ST APT 3",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558053809",
            "telephone_number": "218-590-5397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 CATLIN AVE",
            "address_2": "ROOM 1246",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "54880",
            "telephone_number": "715-395-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "SEAN",
        "middle_name": "WIBERG",
        "credential": "MS LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-06",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "3203",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "2201-39",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Penney, LPC
• Celeste Pennington, LCSW
• Michele Denise Perron, PHD
• Chad M Peterson, PT
• Christine Jo Peterson, MPT
• Steven Frank Peterson
• Kaelin Joy Petzel, RN
• Gina Pfingsten, PT
• Pickering Counseling & Consulting, Inc.
• Martha Pierpont

• Athletic Trainer in Superior, WI
• Providers in Superior, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.