=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558539171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALYNN ANN FELICETTA AP, PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2008
-----------------------------------------------------
Last Update Date | 11/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 TAMIAMI TRL N SUITE 112
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-404-6306
-----------------------------------------------------
Fax | 239-404-6306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 TAMIAMI TRL N SUITE 112
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-404-6306
-----------------------------------------------------
Fax | 239-404-6306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP2233
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT51465
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------