Provider Demographics
NPI:1790236313
Name:PELLEGRINI, GERALD (PTA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W JUDGE PEREZ DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4882
Mailing Address - Country:US
Mailing Address - Phone:504-278-7567
Mailing Address - Fax:504-278-7569
Practice Address - Street 1:801 W JUDGE PEREZ DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4882
Practice Address - Country:US
Practice Address - Phone:504-278-7567
Practice Address - Fax:504-278-7569
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8686225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant