Provider Demographics
NPI:1457692865
Name:PICARELLA, DANIEL DAVID (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
Last Name:PICARELLA
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PENN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1568
Mailing Address - Country:US
Mailing Address - Phone:570-985-9961
Mailing Address - Fax:
Practice Address - Street 1:715 PENN ST APT 2
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1568
Practice Address - Country:US
Practice Address - Phone:570-985-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0051122081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine