Marie Lynn Pettitt

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

355 Adam St
Tonawanda, NY 14150-1903

Phone

(716) 957-2674

NPI assigned

Nov 17, 2020

Last updated

Jan 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1558964056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142213181",
            "telephone_number": "716-957-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 ADAM ST",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141501903",
            "telephone_number": "716-957-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTITT",
        "first_name": "MARIE",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-17",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mariepet@buffalo.edu",
            "affiliation": "N",
            "address_1": "355 Adam St",
            "city": "Tonawanda",
            "state": "NY",
            "country_code": "US",
            "postal_code": "141501903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peter a Rouff DMD PLLC
• Peter a Rouff DMD PLLC
• Jennifer Peterson
• Carlie Pettit
• Justine A Pettit
• Gabriella Mercedes Phifer
• Phillip C Culliton DPM, PC
• Laura Noelle Phillips, LCSW
• Kristine Pieczonka, LCSW
• Brian M Piekarski, PT

• Athletic Trainer in Tonawanda, NY
• Providers in Tonawanda, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.