Individual
TRAVIS PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 BLUEGRASS AVE, LOUISVILLE, KY 40215-1130
(502) 361-2301
Mailing address
1800 BLUEGRASS AVE, LOUISVILLE, KY 40215-1130
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A03896
KY
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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