Provider Demographics
NPI:1619514247
Name:MARCELO, DARYL
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:MARCELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14998 54TH WAY N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2607
Mailing Address - Country:US
Mailing Address - Phone:630-999-1615
Mailing Address - Fax:
Practice Address - Street 1:14998 54TH WAY N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2607
Practice Address - Country:US
Practice Address - Phone:690-999-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy