Provider Demographics
NPI:1275168841
Name:MARCELLETTI, KARISA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:ANN
Last Name:MARCELLETTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1211
Mailing Address - Country:US
Mailing Address - Phone:585-391-0394
Mailing Address - Fax:585-392-8126
Practice Address - Street 1:884 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1718
Practice Address - Country:US
Practice Address - Phone:585-544-4077
Practice Address - Fax:585-544-4070
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist