Provider Demographics
NPI:1124220421
Name:PELLETIER, DENISE MARIE (LPTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PLEASANT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2756
Mailing Address - Country:US
Mailing Address - Phone:413-599-0921
Mailing Address - Fax:
Practice Address - Street 1:34 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9642
Practice Address - Country:US
Practice Address - Phone:413-566-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2159225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant