Provider Demographics
NPI:1922062298
Name:RANGEL, MARCELLA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69-45 108TH STREET
Mailing Address - Street 2:UNIT 7E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:917-816-4676
Mailing Address - Fax:
Practice Address - Street 1:69-45 108TH STREET
Practice Address - Street 2:UNIT 7E
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:917-816-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022679-12251G0304X
NY22679-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM6171Medicare ID - Type Unspecified