Provider Demographics
NPI:1649270067
Name:PELLETIER, LINDA LOUISE (PT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOUISE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-8342
Mailing Address - Country:US
Mailing Address - Phone:717-261-1041
Mailing Address - Fax:
Practice Address - Street 1:142 FRANKLIN FARM LN
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-8901
Practice Address - Country:US
Practice Address - Phone:717-263-5147
Practice Address - Fax:717-263-3454
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001767E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001731000OtherMEDICAL ASSISTANCE PROVID