Individual
DERRY PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
337 OAK GROVE AVE APT I, JACKSON, MI 49203-1394
(517) 416-5297
Mailing address
337 OAK GROVE AVE APT I, JACKSON, MI 49203-1394
(517) 416-5297
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501006216
MI
Other
Enumeration date
10/18/2016
Last updated
10/29/2016
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