Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. MARK E PETTIS, PTA
Active Sole ProprietorCommunity Health Worker · LA PORTE, IN
Registration Details
- NPI Number
- 1982884524
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Nov 12, 2007 (18.440916715268 yrs)
- Last Updated
- Aug 25, 2008
- License
-
06003247A (IN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
203 STANLEY CTLA PORTE, IN, 463504159Browse IN providers · Browse ZIP 46350
- Phone
- 2193622744
- Primary Specialty
-
Community Health Worker
172V00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.