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General NPI Number Information
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NPI Number | 1336189216
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Entity Type | Individual
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Provider Name | NICOLE MARCELLI PT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 397 PALM COAST PARKWAY SW UNIT 4
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City | PALM COAST
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State | FL
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Zip | 32137-4777
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Country | US
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Telephone | 386-447-0610
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Fax | 386-447-0670
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Provider Business Mailing Address
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Address Line | 1012 S CENTRAL AVE
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3723
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Country | US
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Telephone | 386-447-0610
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Fax | 386-447-0670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT 22291
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License Number State | FL
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