Provider Demographics
NPI:1326446477
Name:PELLETIER, BRENDEN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRENDEN
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3152
Mailing Address - Country:US
Mailing Address - Phone:828-274-2188
Mailing Address - Fax:828-274-7843
Practice Address - Street 1:61 WEAVER BLVD STE H
Practice Address - Street 2:SUITE #H
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-6317
Practice Address - Country:US
Practice Address - Phone:828-484-9415
Practice Address - Fax:828-484-9478
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29705225100000X
NC16779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist