Healthcare Provider Details

I. General information

NPI: 1316155658
Provider Name (Legal Business Name): ALISA M. PETRUZZI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 METSKER LN
NOBLESVILLE IN
46062-8921
US

IV. Provider business mailing address

28 NATASHA DR
NOBLESVILLE IN
46062-8429
US

V. Phone/Fax

Practice location:
  • Phone: 317-650-0045
  • Fax: 317-773-9430
Mailing address:
  • Phone: 317-650-0045
  • Fax: 317-773-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1775
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: