Provider Demographics
NPI:1548664782
Name:ROSANELLI, MARIA (ATC/L)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:ROSANELLI
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 LEDGEMONT LN APT 803
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5904
Mailing Address - Country:US
Mailing Address - Phone:972-979-8266
Mailing Address - Fax:
Practice Address - Street 1:1250 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5850
Practice Address - Country:US
Practice Address - Phone:469-593-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36912255A2300X
TX0907021462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer