Provider Demographics
NPI:1518272012
Name:PELTON, DAVID EARL (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EARL
Last Name:PELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SE LYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5016
Mailing Address - Country:US
Mailing Address - Phone:772-521-6834
Mailing Address - Fax:
Practice Address - Street 1:1699 SE LYNGATE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5016
Practice Address - Country:US
Practice Address - Phone:772-521-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist