1124295639 NPI number — MISS JONELLE MARINELLI ROY M.P.T.

Table of content: MISS JONELLE MARINELLI ROY M.P.T. (NPI 1124295639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124295639 NPI number — MISS JONELLE MARINELLI ROY M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
JONELLE
Provider Middle Name:
MARINELLI
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124295639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8956 ALEXANDRA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-452-0681
Provider Business Mailing Address Fax Number:
561-432-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11482 OKEECHOBEE BLVD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-8735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-432-0111
Provider Business Practice Location Address Fax Number:
561-432-1075
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT23972 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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