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General NPI Number Information
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NPI Number | 1093095911
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Entity Type | Individual
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Provider Name | ERIC SCOTT PELLETIER PT DPT PCS C/NDT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 103 PEMBERTON CT
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City | NORTH WALES
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State | PA
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Zip | 19454-4230
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Country | US
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Telephone | 215-855-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PEMBERTON CT
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City | NORTH WALES
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State | PA
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Zip | 19454-4230
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Country | US
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Telephone | 215-855-3216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT011962L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 40QA01276100
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License Number State | NJ
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