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Search › Wisconsin › 174400000X

Jeremiah Petersen, PTA

NPI 1760797203 · on the registry since 2010

Practice

Address
5900 Mockingbird Ln
Greendale, WI 53129
Phone
(414) 423-1399
Organisation at this address
Lcs Greendale Llc
Tp Kcb Harbour Village Opco, Llc
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
174400000X
174400000X
Licence states on file
WI
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2012-12-27

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin