Provider Demographics
NPI:1528216306
Name:PACIELLO, ROGER (PT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:PACIELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FOERY DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6236
Mailing Address - Country:US
Mailing Address - Phone:315-797-9770
Mailing Address - Fax:315-732-7216
Practice Address - Street 1:14 FOERY DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6236
Practice Address - Country:US
Practice Address - Phone:315-797-9770
Practice Address - Fax:315-732-7216
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018014-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist