Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 40QA01276100 | NJ |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT011962L | PA |
NPI | 1093095911 |
---|---|
Provider Name | Dr. Eric Scott Pelletier |
First Address | North Wales, PA 19454-4230 |
Second Address | North Wales, PA 19454-4230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2011 |
Last Update Date | 23/08/2011 |