Kimberly Petusky, PTA
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Northumberland, PA
NPI 1336810050 · NPPES record last updated Sep 22, 2021
Key facts
- NPI
- 1336810050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- TEI000695 (PA)
- Practice address
- 58 Neitz Rd
Northumberland, PA 17857-9608 - Phone
- (570) 473-8366
- NPI assigned
- Sep 22, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TEI000695 | PA | MD | Physical Medicine & Rehabilitation Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | TEI000695 | PA | Yes |
Addresses
Primary practice location
58 Neitz Rd
Northumberland, PA 17857-9608
Mailing address
2447 3Rd St
Bloomsburg, PA 17815-3118
Phone (570) 316-8232
Other providers in Northumberland, PA
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- Orren Eye Associates
- G William Orren
- Pennsylvania CVS Pharmacy, L.L.C.
- Joan Pollock
- Lusai Qiu
- R Bruce Thatcher DMD
- R M Crane DDS PC
- Rachel Reichley
All providers in Northumberland, PA · Physical Medicine & Rehabilitation Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.