Provider Demographics
NPI:1447546494
Name:PECHA, TESSA (PT)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:PECHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY STE B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-839-9266
Mailing Address - Fax:715-839-8761
Practice Address - Street 1:1200 OAKLEAF WAY STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-839-9266
Practice Address - Fax:715-839-8761
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117762251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11776OtherPHYSIICAL THERAPY LICENSE