Provider Demographics
NPI:1740551746
Name:PETERSON, BRITTANY
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 HOWLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3402 HOWLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5633
Practice Address - Country:US
Practice Address - Phone:715-355-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11911-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist