MEDICARE: STEPHEN J PETTIS II ATC

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	2255A2300X	Athletic Trainer		CA
2	2255A2300X	Athletic Trainer	ATR-009254	AZ

General Provider Information

NPI Number	:	1871137455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J PETTIS II ATC

Provider Business Mailing Address
First Line	:	12974 W VIA CAMILLE
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-5300
Country	:	US
Telephone Number	:	619-379-8814
Fax Number	:

Provider Business Practice Location Address
First Line	:	12974 W VIA CAMILLE
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-5300
Country	:	US
Telephone Number	:	619-379-8814
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	05/25/2022

Similar Medicare Providers

1164420832 — SUN CITY NEUROLOGY, P.A.
Practice Location Address:

812 N VIRGINIA ST , SUITE 215
EL PASO, TX
79902-5300

Practice Phone: 915-592-7500
Practice Fax:

1104965490 — GERARD FRANCIS CRECCA MD
Practice Location Address:

1700 CURIE DR , SUITE 5300
EL PASO, TX
79902-2905

Practice Phone: 915-542-2825
Practice Fax: 915-542-1713

1144809294 — PATRICIA BATTLE
Practice Location Address:

812 N VIRGINIA ST STE 100
EL PASO, TX
79902-5300

Practice Phone: 915-701-1110
Practice Fax:

1215918107 — SALIBUS UNITED DRUG PHARMACY
Practice Location Address:

11713 W THUNDERBIRD RD
EL MIRAGE, AZ
85335

Practice Phone: 623-583-9431
Practice Fax: 623-583-2044

1134181332 — LITTLE SMILES OF SURPRISE
Practice Location Address:

13915 N DYSART RD , STE A1
EL MIRAGE, AZ
85335

Practice Phone: 623-444-6340
Practice Fax: 623-444-6350

1730143074 — SHARI D. BERL D.O.
Practice Location Address:

12428 W THUNDERBIRD RD
EL MIRAGE, AZ
85335-3113

Practice Phone: 623-344-6500
Practice Fax: 623-344-6501

Directions to “ STEPHEN J PETTIS II ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.