Individual
LISA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
893 94TH ST, PLEASANT PRAIRIE, WI 53158-4911
(262) 948-0525
Mailing address
893 94TH ST, PLEASANT PRAIRIE, WI 53158-4911
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
06/27/2017
Last updated
02/25/2020
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