Healthcare Provider Details

I. General information

NPI: 1720447832
Provider Name (Legal Business Name): MARCELLA MUGHETTI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CONKEY AVE
NORWICH NY
13815-1756
US

IV. Provider business mailing address

26 CONKEY AVE
NORWICH NY
13815-1756
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-5010
  • Fax: 607-336-7326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62 039985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: