Jeremiah Brad Petersen, PTA

NPI #1760797203 in Greendale, Wisconsin

Provider Information

NPI Number: 1760797203
Entity Type: Individual
Name: Jeremiah Brad Petersen, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: PTA
Enumeration Date: Aug 9, 2010
Last Updated: Dec 27, 2012

Practice Location

Address: 5900 MOCKINGBIRD LN
City: Greendale
State: Wisconsin
ZIP Code: 53129-1459
Phone: (414) 423-1399

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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