Individual
MR. ADRIAN PETTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2510 W RIO SALADO PKWY, MESA, AZ 85201-3603
(301) 275-1176
Mailing address
4600 S FOUR MILE RUN DR APT 634, ARLINGTON, VA 22204-3514
(301) 275-1176
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Enumeration date
07/16/2017
Last updated
10/31/2017
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