Basic Information
| Provider Information | |||||||||
| NPI: | 1194869586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIPOLLETTI | ||||||||
| FirstName: | KELLY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 HAVERHILL RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | AMESBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019132123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783884500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 HAVERHILL RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | AMESBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019132123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783884500 | ||||||||
| FaxNumber: | 9783888255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2007 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15579 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.