Provider Demographics
NPI:1255403713
Name:PETRIS, DEMETRIA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:PETRIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TREEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2436
Mailing Address - Country:US
Mailing Address - Phone:908-322-6629
Mailing Address - Fax:
Practice Address - Street 1:2033 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6013
Practice Address - Country:US
Practice Address - Phone:908-851-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00663700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist