Individual
MR. BRENT A PETRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4910 DIRECTORS PL, SUITE 370, SAN DIEGO, CA 92121-3811
(858) 554-0522
(858) 554-0536
Mailing address
4910 DIRECTORS PL, SUITE 370, SAN DIEGO, CA 92121-3811
(858) 554-0522
(858) 554-0536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT34764
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ971Z
MEDICARE PTAN
CA
Enumeration date
09/05/2008
Last updated
09/01/2016
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