Basic Information
| Provider Information | |||||||||
| NPI: | 1770979817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PECHA | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | L.A.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | W201N16245 ASH DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530379258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627510504 | ||||||||
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| Practice Location | |||||||||
| Address1: | N91W15750 FALLS PKWY | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625321100 | ||||||||
| FaxNumber: | 2625321409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 04/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 407-039 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.