Individual ProviderNicholas James PetersonPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1836 South Ave, La Crosse, WI 54601-5429(608) 782-7300PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas James Peterson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1053035261Provider TypeIndividualFull NamePeterson, Nicholas JamesCredentialPTGenderMaleSole ProprietorNoEnumeration Date9/30/2022Last Updated8/1/2023Contact InformationPractice LocationPractice Address1836 South Ave, La Crosse, WI 54601-5429Phone(608) 782-7300FaxUnlisted FaxMailing LocationMailing Address1836 South Ave, La Crosse, WI 54601-5429Phone(608) 782-7300FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense16111WisconsinCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense13206Minnesota