Individual
MELISSA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5022 S 69TH ST, GREENFIELD, WI 53220-4406
(414) 737-3795
Mailing address
5022 S 69TH ST, GREENFIELD, WI 53220-4406
(414) 737-3795
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1205-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40465800
—
WI
Enumeration date
04/08/2008
Last updated
04/08/2008
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