Individual
ELLIOTT PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2470 FLOWOOD DR, FLOWOOD, MS 39232-9019
(601) 983-2831
Mailing address
112 CHRISTYS LN, BRANDON, MS 39047-6533
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5934
MS
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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