Provider Demographics
NPI:1710915087
Name:MARELL, KAREN L (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MARELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:BEUSCHLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:149 EDINBURGH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4102
Mailing Address - Country:US
Mailing Address - Phone:407-645-5774
Mailing Address - Fax:407-645-3464
Practice Address - Street 1:149 EDINBURGH DR
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4102
Practice Address - Country:US
Practice Address - Phone:407-645-5774
Practice Address - Fax:407-645-3464
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2429OtherBLUE CROSS BLUE SHIELD
FLY2429AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
FLY2429OtherBLUE CROSS BLUE SHIELD