Individual
DANIELE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, CES
Contact information
Practice address
1800 S 4TH ST, AMES, IA 50011-3011
(618) 363-1778
Mailing address
600 LINCOLN AVE, CHARLESTON, IL 61920-3011
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096966
IA
Other
Enumeration date
07/21/2014
Last updated
12/18/2019
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