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Individual
NOLA B PETRUCELLY
Active
Individual
NOLA B PETRUCELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00008073
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0183194
L & I PIN
WA
01
—
5495PE
ASURIS PIN
WA
01
—
7940306
AETNA PIN
WA
05
—
8343634
—
WA
Enumeration date
01/09/2007
Last updated
07/09/2007
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