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NPI Code Detail

MEDICARE: MS. QUERIDA FANELLI MASTERS PTA

MEDICARE: MS. QUERIDA FANELLI MASTERS PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2111MA

General Provider Information

NPI Number : 1073635066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. QUERIDA FANELLI MASTERS PTA
Provider Business Mailing Address
First Line : 8 BOLTON RD
Second Line :
City : ROYALSTON
State : MA
Zip : 01368-8954
Country : US
Telephone Number : 978-249-2281
Fax Number :
Provider Business Practice Location Address
First Line : 130 COLRAIN RD
Second Line :
City : GREENFIELD
State : MA
Zip : 01301-9625
Country : US
Telephone Number : 413-774-3724
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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