MEDICARE: MARCELLA L SCALLY MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	028817	NY

General Provider Information

NPI Number	:	1922179894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELLA L SCALLY MSPT

Provider Business Mailing Address
First Line	:	1564 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-2580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1564 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-2580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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