ETHAN PETTIWAY

CHICAGO, IL
NPI1023153558
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: IL  070014987)
Enumeration Date2007-02-21
Last Update Date2009-12-01
Business Address
-- ETHAN PETTIWAY MPT
500 N KINGSBURY ST
CHICAGO, IL 60654-5721
Phone number: 312-527-5801
Mailing Address
-- ETHAN PETTIWAY MPT
500 KINGSBURY
CHICAGO, IL 60654
Phone number: 312-527-5801
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