Provider Demographics
NPI:1174738017
Name:PETITE, ERNEST E, (CPTA)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:E,
Last Name:PETITE
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16536 HILDEBRANDT RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-8465
Mailing Address - Country:US
Mailing Address - Phone:913-758-1881
Mailing Address - Fax:
Practice Address - Street 1:730 1ST TER
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1704
Practice Address - Country:US
Practice Address - Phone:913-727-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01353225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant