Individual
W MICHAEL PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
14330 S HEATHERWOOD DR, HOMER GLEN, IL 60491-9144
(708) 301-7567
Mailing address
14330 S HEATHERWOOD DR, HOMER GLEN, IL 60491-9144
(708) 301-7567
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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