Individual provider · Type 1 NPI
Jeremiah Brad Petersen, PTA
Specialist · Greendale, WI
NPI number
1760797203
Active
Practice location
5900 Mockingbird Ln
Greendale, WI 53129-1459
Mailing address
133 W Oregon St Apt 202
Milwaukee, WI 53204-1483
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist Primary | 174400000X | 1475-19 (WI) |
Specialist: 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.
2 other providers at this address
Other specialist providers in Greendale
About NPI 1760797203
Jeremiah Brad Petersen, PTA's National Provider Identifier is 1760797203, issued on Aug 9, 2010. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Greendale, WI. The record was last updated on Dec 27, 2012.