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1134641608
ADRIAN PETTAWAY
MESA, AZ
NPI
1134641608
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
Additional Taxonomies
225700000X Massage Therapist
Enumeration Date
2017-07-16
Last Update Date
2017-10-31
Business Address
Mr. ADRIAN PETTAWAY ATC
2510 W RIO SALADO PKWY
MESA, AZ 85201-3603
Phone number: 301-275-1176
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Mailing Address
Mr. ADRIAN PETTAWAY ATC
4600 S FOUR MILE RUN DR APT 634
ARLINGTON, VA 22204-3514
Phone number: 301-275-1176
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