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General NPI Number Information
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NPI Number | 1124365028
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Entity Type | Individual
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Provider Name | SARAH BETHANY PETRISIN MSED, ATC, NCMT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 7473 EISENHOWER ST
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City | VENTURA
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State | CA
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Zip | 93003-2485
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Country | US
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Telephone | 315-591-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 7473 EISENHOWER ST
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City | VENTURA
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State | CA
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Zip | 93003-2485
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Country | US
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Telephone | 315-591-1166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000935
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019007248
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 70569
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License Number State | CA
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