Provider Demographics
NPI:1750911236
Name:OLIVERI, MARCELLO (DPT)
Entity type:Individual
Prefix:
First Name:MARCELLO
Middle Name:
Last Name:OLIVERI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8263
Mailing Address - Country:US
Mailing Address - Phone:570-517-0511
Mailing Address - Fax:570-421-7091
Practice Address - Street 1:600 PLAZA CT
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8263
Practice Address - Country:US
Practice Address - Phone:570-517-0511
Practice Address - Fax:570-421-7091
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid