Provider Demographics
NPI:1780381202
Name:PETETT SPORTS AND PERFORMANCE THERAPY, LLC
Entity type:Organization
Organization Name:PETETT SPORTS AND PERFORMANCE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:PETETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:270-407-3177
Mailing Address - Street 1:745 WESTCOTT LN
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-4046
Mailing Address - Country:US
Mailing Address - Phone:270-407-3177
Mailing Address - Fax:
Practice Address - Street 1:2141 UTOPIA AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2051
Practice Address - Country:US
Practice Address - Phone:270-407-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy