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Individual

ETHAN PETTIWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
500 N KINGSBURY ST, CHICAGO, IL 60654-5721
(312) 527-5801
(312) 644-4567
Mailing address
500 KINGSBURY, CHICAGO, IL 60654
(312) 527-5801
(312) 644-4567

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070014987
IL

Other

Enumeration date
02/21/2007
Last updated
12/01/2009
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