Provider Demographics
NPI:1811941131
Name:PELLETIER, DANIELLE MARIE (MSPT)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:MARIE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7857 N UNIVERSITY DR STE 401
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2600
Mailing Address - Country:US
Mailing Address - Phone:954-659-5370
Mailing Address - Fax:954-659-5371
Practice Address - Street 1:7857 N UNIVERSITY DR STE 401
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2600
Practice Address - Country:US
Practice Address - Phone:954-659-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02011225100000X
MA16392225100000X
FLPT327562251X0800X
AZ9000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9000OtherPT LICENSE
RIPT02011OtherPHYSICAL THERAPY LICENSE
MA16392OtherPHYSICAL THERAPY LICENSE
FLPT32756OtherPHYSICAL THERAPIST