Melissa Peterson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1205-019 Issued in WI

Practice address

5022 S 69TH St
Greenfield, WI 53220-4406

Phone

(414) 737-3795

NPI assigned

Apr 8, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1912170291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5022 S 69TH ST",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204406",
            "telephone_number": "414-737-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5022 S 69TH ST",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204406",
            "telephone_number": "414-737-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MELISSA",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1205-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40465800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristi Peroceschi
• Deirdre Danielle Peters, OTR
• James R Peters, DPT
• Anne L Petersen-Fisher, MD
• Yvonne Elizabeth Petersen-Zich, M.S.
• Viranda M Pfannenstiel, PTA
• Melissa Pfeifer, OTR
• Zachary E. Pflum, M.D.
• Steven Phaklides, PTA
• Van Thi Hong Phan, NP

• Physical Therapy Assistant in Greenfield, WI
• Providers in Greenfield, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.