Provider Demographics
NPI:1295086684
Name:BARICELLI, ANGEL E (PT, MSPT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:E
Last Name:BARICELLI
Suffix:
Gender:M
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S HUNTINGTON AVE
Mailing Address - Street 2:# 24
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4720
Mailing Address - Country:US
Mailing Address - Phone:781-866-9231
Mailing Address - Fax:
Practice Address - Street 1:653 SUMMER ST
Practice Address - Street 2:FLOOR # 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2108
Practice Address - Country:US
Practice Address - Phone:617-269-6262
Practice Address - Fax:617-269-1068
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist