Provider Demographics
NPI:1073954434
Name:PELETZ, KATIE M (DPT)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:M
Last Name:PELETZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SUMMIT AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7534
Mailing Address - Country:US
Mailing Address - Phone:607-435-0527
Mailing Address - Fax:
Practice Address - Street 1:322 SUMMIT AVE
Practice Address - Street 2:APT. 1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7534
Practice Address - Country:US
Practice Address - Phone:607-435-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist