Individual
BRYAN KEITH PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N., CCM
Contact information
Practice address
5555 GLENDON CT, DUBLIN, OH 43016-3249
(877) 641-2010
Mailing address
PO BOX 474, JACKSON, OH 45640-0474
(740) 286-8646
(740) 286-4676
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00049080
CCM
OH
01
—
RN262281
OH BOARD OF NURSING
OH
Enumeration date
10/03/2007
Last updated
10/03/2007
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