Provider Demographics
NPI:1427506336
Name:PELLEGRINO, EMILY S (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:S
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:S
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CSCS
Mailing Address - Street 1:1515 ROARING SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4159
Mailing Address - Country:US
Mailing Address - Phone:919-454-1737
Mailing Address - Fax:
Practice Address - Street 1:1515 ROARING SPRINGS LN
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-4159
Practice Address - Country:US
Practice Address - Phone:919-454-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3390225100000X
TX1391750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist