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JEREMIAH BRAD PETERSEN PTA
NPI 1760797203
Specialist in Greendale, WI

Active since August 09, 2010
5900 MOCKINGBIRD LN, GREENDALE, WI 53129(414) 423-1399 Get Directions Write a Review

NPPES record last updated: December 27, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jeremiah Brad Petersen Pta NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEREMIAH BRAD PETERSEN PTA (NPI 1760797203) is an individual specialist in Greendale, Wisconsin, licensed in Wisconsin (1475-19) and active in the NPI registry since August 2010.

NPPES Registry Identity

NPI1760797203
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameJEREMIAH BRAD PETERSENCredential: PTA
Location Address5900 MOCKINGBIRD LNGreendale, WI 53129-1459
Mailing Address133 W Oregon St Apt 202Milwaukee, WI 53204-1483
Phone(414) 423-1399
Sole ProprietorNo
Enumeration DateAugust 9, 2010
Last NPPES UpdateDecember 27, 2012
✔ NPI 1760797203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in WI · 1475-19
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
5900 MOCKINGBIRD LN, Greendale, WI 53129
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TP KCB HARBOUR VILLAGE OPCO, LLC
Assisted Living Facility
5900 MOCKINGBIRD LN
GREENDALE, WI 53129
Milwaukee County (414) 421-9600
LCS GREENDALE LLC
Assisted Living Facility
5900 MOCKINGBIRD LN
GREENDALE, WI 53129
Milwaukee County (414) 982-4097

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeremiah Petersen's NPI number?

The NPI number for Jeremiah Petersen is 1760797203. It was assigned to this individual provider in the NPPES registry on August 9, 2010.

Where is Jeremiah Petersen located?

Jeremiah Petersen practices at 5900 Mockingbird Ln, Greendale, WI 53129. The listed phone number is (414) 423-1399.

What is Jeremiah Petersen's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Jeremiah Petersen was last updated on December 27, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.