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Individual

JASON PETTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1570 W RESERVOIR ST, WYTHEVILLE, VA 24382-1500
(276) 228-5411
Mailing address
202 PAINTER ST, GALAX, VA 24333-3830
(276) 236-5164

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001636
VA

Other

Enumeration date
11/29/2019
Last updated
11/29/2019
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