Provider Demographics
NPI:1447388640
Name:TONELLO, JEFFREY R (OPA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:TONELLO
Suffix:
Gender:M
Credentials:OPA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-1516
Mailing Address - Country:US
Mailing Address - Phone:508-889-0880
Mailing Address - Fax:508-888-3145
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:YAWKEY ACC 3 ORTHOPAEDICS
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:671-414-2598
Practice Address - Fax:617-414-2556
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH-512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAH-51OtherALLIED HEALTH