Provider Demographics
NPI:1154813772
Name:MORELLO, ASJA (ATC)
Entity type:Individual
Prefix:
First Name:ASJA
Middle Name:
Last Name:MORELLO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17651 OAK CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920
Mailing Address - Country:US
Mailing Address - Phone:239-244-6605
Mailing Address - Fax:
Practice Address - Street 1:17651 OAK CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920
Practice Address - Country:US
Practice Address - Phone:239-244-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer