Provider Demographics
NPI:1629717111
Name:PETSAS, ANAMARIA (MAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANAMARIA
Middle Name:
Last Name:PETSAS
Suffix:
Gender:F
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:PETSAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14860 FAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2412
Mailing Address - Country:US
Mailing Address - Phone:216-256-8008
Mailing Address - Fax:
Practice Address - Street 1:18697 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program