Individual
KIESHA E PETTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 4TH ST N STE 15235, ST PETERSBURG, FL 33702-4305
(727) 304-4705
Mailing address
7901 4TH ST N STE 15235, ST PETERSBURG, FL 33702-4305
(727) 304-4705
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/14/2023
Last updated
07/09/2023
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