Individual
JERRY PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
444 FOUR STATES DR., STE 1, GALENA, KS 66739-4325
(620) 783-4441
(620) 783-4090
Mailing address
PO BOX 2546, JOPLIN, MO 64803-2546
(620) 783-4441
(620) 783-4090
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1403135
KS
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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