Eric Scott Pelletier, PT DPT PCS C/NDT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT011962L Issued in PA

Practice address

103 Pemberton CT
North Wales, PA 19454-4230

Phone

(215) 855-3216

NPI assigned

Aug 23, 2011

Last updated

Aug 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1093095911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 PEMBERTON CT",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194544230",
            "telephone_number": "215-855-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 PEMBERTON CT",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194544230",
            "telephone_number": "215-855-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETIER",
        "first_name": "ERIC",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PT DPT PCS C/NDT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-23",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "PA",
            "license": "PT011962L",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NJ",
            "license": "40QA01276100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in North Wales, PA
• Providers in North Wales, PA by specialty
• Pediatric Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.