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1023153558
ETHAN PETTIWAY
CHICAGO, IL
NPI
1023153558
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: IL 070014987)
Enumeration Date
2007-02-21
Last Update Date
2009-12-01
Business Address
-- ETHAN PETTIWAY MPT
500 N KINGSBURY ST
CHICAGO, IL 60654-5721
Phone number: 312-527-5801
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Mailing Address
-- ETHAN PETTIWAY MPT
500 KINGSBURY
CHICAGO, IL 60654
Phone number: 312-527-5801
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