Provider Demographics
NPI:1598139743
Name:PETREE, MILTON
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:PETREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 HUCKABEE BND
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6526
Mailing Address - Country:US
Mailing Address - Phone:512-945-8580
Mailing Address - Fax:
Practice Address - Street 1:20800 HUCKABEE BND
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6526
Practice Address - Country:US
Practice Address - Phone:512-945-8580
Practice Address - Fax:512-770-6130
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility