MEDICARE: MRS. DEBRA MARIE PETTY MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6209	CO

General Provider Information

NPI Number	:	1497868467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA MARIE PETTY MSPT

Provider Business Mailing Address
First Line	:	1388 SEVEN LAKES DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-7213
Country	:	US
Telephone Number	:	970-669-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 E 29TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2733
Country	:	US
Telephone Number	:	970-663-3720
Fax Number	:	970-667-7682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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