Provider Demographics
NPI:1790775534
Name:ANTONELLI, JUDY ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ELLEN
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4027
Mailing Address - Country:US
Mailing Address - Phone:603-893-6872
Mailing Address - Fax:
Practice Address - Street 1:101 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3766
Practice Address - Country:US
Practice Address - Phone:781-229-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0395773Medicare ID - Type Unspecified