Provider Demographics
NPI:1457786204
Name:IZZICUPO, MEREDITH R (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:R
Last Name:IZZICUPO
Suffix:
Gender:F
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:R
Other - Last Name:HARCLERODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, SCS
Mailing Address - Street 1:1293 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-3542
Mailing Address - Country:US
Mailing Address - Phone:201-317-9683
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:CAMBRIDGE HEALTH ALLIANCE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145
Practice Address - Country:US
Practice Address - Phone:617-591-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist