Provider Demographics
NPI:1740901081
Name:PETTI REHABILITATION LLC
Entity type:Organization
Organization Name:PETTI REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:315-401-5055
Mailing Address - Street 1:5564 HORN RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9304
Mailing Address - Country:US
Mailing Address - Phone:315-401-5055
Mailing Address - Fax:949-222-4407
Practice Address - Street 1:5564 HORN RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512-9304
Practice Address - Country:US
Practice Address - Phone:315-401-5055
Practice Address - Fax:949-222-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy