Healthcare Provider Details

I. General information

NPI: 1457549784
Provider Name (Legal Business Name): CLAIRE PETRULAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 36TH ST STE 100
VERO BEACH FL
32960-6587
US

IV. Provider business mailing address

610 FLAMEVINE LN
VERO BEACH FL
32963-1829
US

V. Phone/Fax

Practice location:
  • Phone: 772-778-2009
  • Fax:
Mailing address:
  • Phone: 617-275-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17212
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: