Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ian B Petersen, ATC-L

Individual provider Athletic Trainer · NPI 1255305850

Ian B Petersen, ATC-L is an Athletic Trainer in South Holland, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
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Practice location Address checks out

345 Taft Rd
South Holland, IL 60473
Phone: (708) 596-0107
Fax: (708) 671-0767
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X (IL)

Record details

NPI number1255305850
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC-L
Sole proprietorNo
NPI enumeratedFebruary 13, 2006
Last updated in NPPESNovember 26, 2007

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