Healthcare Provider Details

I. General information

NPI: 1497221295
Provider Name (Legal Business Name): MARCELO KNAPIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 TRAVELER ST STE G
BOSTON MA
02118-2232
US

IV. Provider business mailing address

14 BENNETT PL
MEDFORD MA
02155-6678
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-6300
  • Fax: 617-623-4224
Mailing address:
  • Phone: 781-608-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23879
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: