Provider Demographics
NPI:1801400783
Name:STELLATO, MARIE ALICE (LPTA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ALICE
Last Name:STELLATO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:FINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:233 LOTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2423
Mailing Address - Country:US
Mailing Address - Phone:978-895-7201
Mailing Address - Fax:
Practice Address - Street 1:111 HEADWATERS DR
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1028
Practice Address - Country:US
Practice Address - Phone:508-430-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA716225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant