Active NPI
Misty Susanne Petro, PTA,ATC,CSCS
- Specialist
- Bloomington, IN
National Provider Identifier
1013174051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 99032299A
- Practice address
- 1355 W Bloomfield Rd Ste B
Bloomington, IN 47403-2052 - Phone
- (812) 336-7910
- NPI assigned
- May 19, 2008
- Last updated
- May 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 99032299A | IN | Primary |
Addresses
Primary practice location
1355 W Bloomfield Rd Ste B
Bloomington, IN 47403-2052
Mailing address
1355 W Bloomfield Rd Ste B
Bloomington, IN 47403-2052
Phone (812) 336-7910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99032299A | IN | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physiotherapy Associates Inc | Past | Accepting new patients | |
| Physiotherapy Associates Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Estero, FL
- NPI 1720039902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1013174051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1355 W BLOOMFIELD RD STE B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032052",
"telephone_number": "812-336-7910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 W BLOOMFIELD RD STE B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032052",
"telephone_number": "812-336-7910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRO",
"first_name": "MISTY",
"middle_name": "SUSANNE",
"credential": "PTA,ATC,CSCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-19",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IN",
"license": "99032299A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.