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Individual

MISTY SUSANNE PETRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA,ATC,CSCS

Contact information

Practice address
1355 W BLOOMFIELD RD STE B, BLOOMINGTON, IN 47403-2052
(812) 336-7910
Mailing address
1355 W BLOOMFIELD RD STE B, BLOOMINGTON, IN 47403-2052
(812) 336-7910

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
99032299A
IN

Other

Enumeration date
05/19/2008
Last updated
05/19/2008
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