Provider Demographics
NPI:1689269680
Name:PELLETIER, RUTH ESTHER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ESTHER
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PLEASANT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4088
Mailing Address - Country:US
Mailing Address - Phone:207-321-1472
Mailing Address - Fax:
Practice Address - Street 1:22 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1318
Practice Address - Country:US
Practice Address - Phone:207-781-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA5713225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant