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General NPI Number Information
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NPI Number | 1679847610
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Entity Type | Individual
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Provider Name | DANIELA MARTINEZ PACULL PT, DPT, LMT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 1493 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1047
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Country | US
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Telephone | 617-665-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 7 WALTER TER APT 2
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City | SOMERVILLE
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State | MA
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Zip | 02145-2915
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Country | US
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Telephone | 617-718-2783
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 19009
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10433
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License Number State | MA
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