Provider Demographics
NPI:1205590197
Name:GULOTTA, MARIELLE FOX (DPT)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:FOX
Last Name:GULOTTA
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 1:115 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1709
Mailing Address - Country:US
Mailing Address - Phone:516-524-8316
Mailing Address - Fax:
Practice Address - Street 1:913 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2364
Practice Address - Country:US
Practice Address - Phone:516-454-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist