Provider Demographics
NPI:1033702337
Name:PETTITT, GINGER MEGAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:MEGAN
Last Name:PETTITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BRIARCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8731
Mailing Address - Country:US
Mailing Address - Phone:865-481-6009
Mailing Address - Fax:
Practice Address - Street 1:300 BRIARCLIFF AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8731
Practice Address - Country:US
Practice Address - Phone:865-481-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000001814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant