Provider Demographics
NPI:1952734543
Name:ANELLO, CAITLIN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:ANELLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ACADEMY RD NE
Mailing Address - Street 2:APT 41
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3350
Mailing Address - Country:US
Mailing Address - Phone:505-688-7876
Mailing Address - Fax:
Practice Address - Street 1:4821 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1226
Practice Address - Country:US
Practice Address - Phone:505-266-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist