Individual
MR. JEREMY THOMAS PETTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
126 E MAIN ST, GRANGEVILLE, ID 83530-2211
(208) 406-5195
Mailing address
PO BOX 327, GRANGEVILLE, ID 83530-0327
(208) 406-5195
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1913
ID
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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