Provider Demographics
NPI:1649370842
Name:PUNIELLO, MICHAEL STEPHEN (DPT, MS, OCS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:PUNIELLO
Suffix:
Gender:M
Credentials:DPT, MS, OCS
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Mailing Address - Street 1:100 STATION ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2243
Mailing Address - Country:US
Mailing Address - Phone:781-749-5833
Mailing Address - Fax:781-740-9141
Practice Address - Street 1:100 STATION ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2243
Practice Address - Country:US
Practice Address - Phone:781-749-5833
Practice Address - Fax:781-740-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65170OtherBLUE CROSS
MA0003737OtherNEIGHBORHOOD HEALTH PLAN
MA600797OtherHARVARD PILGRIM
MA708703OtherTUFTS HEALTH PLAN
MAY65170OtherMEDICARE ID
MA6400201OtherUNITED HEALTH CARE