Provider Demographics
NPI:1699725093
Name:MARCEL, THERESA ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:MARCEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:AVERSANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:73 VANTINE RD
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2204
Mailing Address - Country:US
Mailing Address - Phone:845-626-8104
Mailing Address - Fax:
Practice Address - Street 1:73 VANTINE RD
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-2204
Practice Address - Country:US
Practice Address - Phone:845-626-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021687-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist