Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jeremiah Brad Petersen, PTA

Individual provider Specialist · NPI 1760797203

Jeremiah Brad Petersen, PTA is a Specialist in Greendale, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2010.

Licensed in
WI
In the registry since
2010
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

5900 Mockingbird Ln
Greendale, WI 53129-1459
Phone: (414) 423-1399
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 1475-19 (WI)

Record details

NPI number1760797203
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedAugust 9, 2010
Last updated in NPPESDecember 27, 2012

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