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General NPI Number Information
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NPI Number | 1538789953
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Entity Type | Individual
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Provider Name | WILLIAM PETTIT PTA
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Gender | Male
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Dates
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Enumeration Date | 04/26/2020
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Last Update Date | 04/26/2020
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Provider Practice Location Address
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Address Line | 8055 E TUFTS AVE
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City | DENVER
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State | CO
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Zip | 80237-2835
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Country | US
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Telephone | 303-247-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E 10TH AVE APT 203
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City | DENVER
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State | CO
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Zip | 80203-3243
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Country | US
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Telephone | 719-629-6633
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.0013079
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License Number State | CO
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