Peter M. Petrusic, MS, ATC, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3954 Issued in SC

Practice address

7467 Saint Andrews Rd Ste 9
Irmo, SC 29063-2876

Phone

(803) 749-5031

NPI assigned

Apr 16, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523836800000",
    "number": "1265929285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 N LAKE DR APT 1524",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292128121",
            "telephone_number": "585-750-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7467 SAINT ANDREWS RD STE 9",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632876",
            "telephone_number": "803-749-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSIC",
        "first_name": "PETER",
        "middle_name": "M.",
        "credential": "MS, ATC, PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "2403",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "3954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Peak
• Mark G. Pelletier, D.D.S.
• Alicia Pendergrass, FNP
• Nicole Janay Perez
• Stephanie C Peterson, PA
• Margaret Livingston Phillips, DMD
• Jeanita Dunlap Pinkerton, PHARM.D.
• Angela B. Pitts, MS, LMHC, LPC, NCC
• Bryson Platt
• Karen P Pollock, M.D.

• Physical Therapy Assistant in Irmo, SC
• Providers in Irmo, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.