Individual
JON PETKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
690 MINOT AVE STE 2, AUBURN, ME 04210-3922
(207) 783-3450
Mailing address
16 UPLAND RD, LISBON, ME 04250-6805
(207) 333-1863
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2735
LICENSE#
ME
Enumeration date
11/07/2006
Last updated
07/08/2007
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