Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5321 | NC |
NPI | 1003113242 |
---|---|
Provider Name | Marc J Pelletier |
First Address | Hickory, NC 28602-9617 |
Second Address | Hickory, NC 28602-9617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2011 |
Last Update Date | 24/02/2011 |