Individual
LORI PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10330 PRAIRIE RIDGE BLVD, PLEASANT PRAIRIE, WI 53158-1947
(262) 612-2831
(262) 612-2893
Mailing address
7531 32ND AVE, KENOSHA, WI 53142-4429
(262) 496-6607
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2486-19
WI
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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