Provider Demographics
NPI:1316155658
Name:PETRUZZI, ALISA M (PT)
Entity type:Individual
Prefix:MS
First Name:ALISA
Middle Name:M
Last Name:PETRUZZI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:28 NATASHA DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8429
Mailing Address - Country:US
Mailing Address - Phone:317-650-0045
Mailing Address - Fax:317-773-9430
Practice Address - Street 1:33 METSKER LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8921
Practice Address - Country:US
Practice Address - Phone:317-650-0045
Practice Address - Fax:317-773-9430
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist