Provider Demographics
NPI:1093095911
Name:PELLETIER, ERIC SCOTT (PT DPT PCS C/NDT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:PT DPT PCS C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PEMBERTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4230
Mailing Address - Country:US
Mailing Address - Phone:215-855-3216
Mailing Address - Fax:
Practice Address - Street 1:103 PEMBERTON CT
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-4230
Practice Address - Country:US
Practice Address - Phone:215-855-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011962L2251P0200X
NJ40QA012761002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics