Healthcare Provider Details

I. General information

NPI: 1053229963
Provider Name (Legal Business Name): ANDREW THOMAS PELLETTIERE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 W GARFIELD AVE
BARTONVILLE IL
61607-1746
US

IV. Provider business mailing address

1119 W GARFIELD AVE
BARTONVILLE IL
61607-1746
US

V. Phone/Fax

Practice location:
  • Phone: 309-839-0470
  • Fax: 309-839-0664
Mailing address:
  • Phone: 309-839-0470
  • Fax: 309-839-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: