Individual
TERRY PANTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1950 RIDGEDALE RD, SOUTH BEND, IN 46614-2243
(574) 291-6722
Mailing address
19167 GLENDALE AVE, SOUTH BEND, IN 46637-2706
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002163A
IN
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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