Provider Demographics
NPI:1629315965
Name:PETYN, ALINA F (PT)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:F
Last Name:PETYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 CARLSBAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1950
Mailing Address - Country:US
Mailing Address - Phone:760-585-7720
Mailing Address - Fax:866-496-5620
Practice Address - Street 1:1281 CARLSBAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1950
Practice Address - Country:US
Practice Address - Phone:760-585-7720
Practice Address - Fax:866-496-5620
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist