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NPI Code Detail

MEDICARE: MRS. TRISHA M PETERSON PTA

MEDICARE: MRS. TRISHA M PETERSON PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1388-019WI

General Provider Information

NPI Number : 1952540767
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRISHA M PETERSON PTA
Provider Business Mailing Address
First Line : 3271 NORTH ST
Second Line :
City : EAST TROY
State : WI
Zip : 53120-1147
Country : US
Telephone Number : 262-642-3995
Fax Number :
Provider Business Practice Location Address
First Line : 3271 NORTH ST
Second Line :
City : EAST TROY
State : WI
Zip : 53120-1147
Country : US
Telephone Number : 262-642-3995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2009
Last Update Date : 02/18/2009

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