Basic Information
| Provider Information | |||||||||
| NPI: | 1245835362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELLETIER | ||||||||
| FirstName: | MEAGAN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 383 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | MADAWASKA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047563004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073169583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 163 VAN BUREN RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047363588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074981618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2020 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5848 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.