Individual
PENNY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
713 N LEONARD ST, WEST SALEM, WI 54669-1229
(608) 786-2274
Mailing address
W7812 AMSTERDAM PRAIRIE RD, HOLMEN, WI 54636-9394
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
60-019
WI
Other
Enumeration date
12/15/2006
Last updated
07/08/2007
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