Provider Demographics
NPI:1578714374
Name:FRANCISCO, MARELA
Entity Type:Individual
Prefix:
First Name:MARELA
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12836 OLD GLENN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7041
Mailing Address - Country:US
Mailing Address - Phone:907-694-8085
Mailing Address - Fax:
Practice Address - Street 1:12836 OLD GLENN HWY STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7041
Practice Address - Country:US
Practice Address - Phone:907-694-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist