Most Relevant Information
Provider Data
| NPI Number: | 1003425216 |
| Provider Name: | MICHAEL KEITH PETITT LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 165118 |
Most Important Dates
| Enumeration Date: | 07/24/2020 |
| Last Updated: | 07/24/2020 |
Provider Practice Location
605 MAIN STREET
SHARPSBURG
KY
40374
Practice Location Phone/Fax
| Phone: | 6063360246 |
| Fax: |
Provider Mailing Location
PO BOX 208
SHARPSBURG
KY
403740208
Provider Mailing Phone/Fax
| Phone: | 6063360246 |
| Fax: |