Provider Demographics
NPI:1477792059
Name:PETTIT, CHRISTAL ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTAL
Middle Name:ANN
Last Name:PETTIT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:CHRISTAL
Other - Middle Name:ANN
Other - Last Name:GEARHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:2224 N. SMITH RD.
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9323
Mailing Address - Country:US
Mailing Address - Phone:517-646-9780
Mailing Address - Fax:517-646-9780
Practice Address - Street 1:2224 N. SMITH RD.
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-9323
Practice Address - Country:US
Practice Address - Phone:517-646-9780
Practice Address - Fax:517-646-9780
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist