Individual
MR. KEVIN L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 961-4160
Mailing address
6901 N ARDARA AVE, GLENDALE, WI 53209-2910
(414) 940-4910
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5318024
WI
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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