Provider Demographics
NPI:1689190480
Name:CALDERONE, BIANCA (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CALDERONE
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINEVALE AVE
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-1012
Mailing Address - Country:US
Mailing Address - Phone:781-844-4971
Mailing Address - Fax:
Practice Address - Street 1:1 PINEVALE AVE
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-1012
Practice Address - Country:US
Practice Address - Phone:781-844-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029482225100000X
MA23236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist