Individual
PETER M. PETRUSIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PTA
Contact information
Practice address
7467 SAINT ANDREWS RD STE 9, IRMO, SC 29063-2876
(803) 749-5031
Mailing address
2170 N LAKE DR APT 1524, COLUMBIA, SC 29212-8121
(585) 750-0719
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3954
SC
2255A2300X
Athletic Trainer
2403
SC
Other
Enumeration date
04/16/2018
Last updated
04/16/2018
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