Provider Demographics
NPI:1902443989
Name:MARCELLO, CAROLYN NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:NICOLE
Last Name:MARCELLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 MILL RD UNIT 2208
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4188
Mailing Address - Country:US
Mailing Address - Phone:860-989-6413
Mailing Address - Fax:
Practice Address - Street 1:340 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4020
Practice Address - Country:US
Practice Address - Phone:978-287-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist