Provider Demographics
NPI:1760615397
Name:PELLETIER, LINDA J (RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 HATCHETTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1512
Mailing Address - Country:US
Mailing Address - Phone:860-434-4800
Mailing Address - Fax:860-434-4834
Practice Address - Street 1:44 HATCHETTS HILL RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1512
Practice Address - Country:US
Practice Address - Phone:860-434-4800
Practice Address - Fax:860-434-4834
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist