Individual
RICHARD PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 N BRIARCLIFF DR, APPLETON, WI 54915-2959
(920) 739-4466
Mailing address
601 N BRIARCLIFF DR, APPLETON, WI 54915-2959
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1320-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40070600
—
WI
Enumeration date
05/23/2008
Last updated
05/23/2008
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