JEREMIAH BRAD PETERSEN PTA NPI 1760797203

NPI Information

NPI: 1760797203
Provider Name: JEREMIAH BRAD PETERSEN, PTA
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
5900 MOCKINGBIRD LN
GREENDALE, WI
ZIP 53129
Phone: (414) 423-1399
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Jeremiah Brad Petersen, PTA is a specialist in Greendale, WI. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Jeremiah Brad Petersen, PTA NPI is 1760797203. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5900 MOCKINGBIRD LN
GREENDALE, WI
ZIP 53129-459
Phone: (414) 423-1399

The enumeration date for this NPI number is 8/9/2010 and was last updated on 12/27/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		1475-19	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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