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General NPI Number Information
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NPI Number | 1578225082
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Entity Type | Individual
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Provider Name | AMY PECK PTA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 2020 S MUSKEGO AVE
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City | MILWAUKEE
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State | WI
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Zip | 53204-3622
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Country | US
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Telephone | 414-383-2630
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 S MUSKEGO AVE
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City | MILWAUKEE
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State | WI
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Zip | 53204-3622
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Country | US
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Telephone | 414-383-2630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3139
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License Number State | WI
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