Misty Susanne Petro, PTA,ATC,CSCS

NPI #1013174051 in Bloomington, Indiana

Provider Information

NPI Number: 1013174051
Entity Type: Individual
Name: Misty Susanne Petro, PTA,ATC,CSCS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: PTA,ATC,CSCS
Enumeration Date: May 19, 2008
Last Updated: May 19, 2008

Practice Location

Address: 1355 W BLOOMFIELD RD STE B
City: Bloomington
State: Indiana
ZIP Code: 47403-2052
Phone: (812) 336-7910

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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