Provider Demographics
NPI:1831679331
Name:FERREIRA, MARIANE PISTELLI (PT)
Entity Type:Individual
Prefix:
First Name:MARIANE
Middle Name:PISTELLI
Last Name:FERREIRA
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 1:1701 SAN PABLO RD S APT 809
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2098
Mailing Address - Country:US
Mailing Address - Phone:352-792-5398
Mailing Address - Fax:
Practice Address - Street 1:13500 SUTTON PARK DR S STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5291
Practice Address - Country:US
Practice Address - Phone:904-371-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist