IndividualActive
Mark Pettis, PTA
NPI 1982884524 · Community Health Worker · La Porte, IN
Provider details
- NPI number
- 1982884524
- Entity type
- Individual
- Primary specialty
- Community Health WorkerOther Service Providers
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- Yes
- License
- 06003247A (IN)
Specialties & taxonomies
Other Service Providers
Practice location
203 Stanley Ct
La Porte, IN 46350-4159
Phone: (219) 362-2744
Approximate (ZIP-level) locationGet directions
Mailing address
203 Stanley Ct
La Porte, IN 46350-4159
Registry dates
- Enumerated
- 2007-11-12
- Last updated
- 2008-08-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.