Individual
MR. GARY COURTLAND PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1616 FRANCES AVE, FORT PIERCE, FL 34949-3559
(772) 519-9197
Mailing address
1616 FRANCES AVE, FORT PIERCE, FL 34949-3559
(772) 519-9197
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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