Individual
ETHAN THOMAS PRAVETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CCI
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
040.0124005
VT
225100000X
Physical Therapist
Primary
042312-1
NY
225100000X
Physical Therapist
22214
MA
225100000X
Physical Therapist
4111
NH
Other
Enumeration date
07/06/2016
Last updated
04/16/2020
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