1689918658 NPI number — MISS TAMARA MARIA MEROLLI PT

Table of content: MISS TAMARA MARIA MEROLLI PT (NPI 1689918658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689918658 NPI number — MISS TAMARA MARIA MEROLLI PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEROLLI
Provider First Name:
TAMARA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1689918658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 BOSTON POST RD E
Provider Second Line Business Mailing Address:
SUITE 221
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752-3527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-481-5519
Provider Business Mailing Address Fax Number:
508-481-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 BOSTON POST RD E
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-481-5519
Provider Business Practice Location Address Fax Number:
508-481-6106
Provider Enumeration Date:
11/15/2012

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:  040.0077014 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 040.0077014 . This is a "PHYSICAL THERAPY LISCENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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