Individual
MR. MICHAEL RAYMOND PETRARCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., A.T.C
Contact information
Practice address
12570 VENICIA DR, FORT MYERS, FL 33913-8145
(603) 978-1261
Mailing address
12570 VENICIA DR, FORT MYERS, FL 33913-8145
(603) 978-1261
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
977
AL
Other
Enumeration date
10/22/2008
Last updated
10/22/2008
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