Pettis, Susan V

Pettis, Susan V is an individual health care provider with primary practice located at 11551 Tanglewood Lake Circle Suite 2, Anchorage AK 99516-1304. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Pettis, Susan V can be contacted via phone (907) 562-7745.

Contact Information

Primary practice address
11551 Tanglewood Lake Circle Suite 2 Anchorage AK 99516-1304
Phone: (907) 562-7745
Fax: (907) 562-7808
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 67 Alaska

Profile Details

NPI number 1346204658
LBN Legal business name Pettis, Susan V
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Sep 2nd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346204658 NPPES
Alaska MEDICAID PT0577

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