Individual
MR. GLENN AUSTIN PETRAITIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
800 E GATE BLVD, GARDEN CITY, NY 11530-2105
(831) 849-6000
Mailing address
18 TONY DR, KINGS PARK, NY 11754-5036
(631) 626-5611
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014170-01
NY
Other
Enumeration date
01/02/2025
Last updated
01/02/2025
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