Provider Demographics
NPI:1194783241
Name:MARZULLO, MATTHEW A (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:MARZULLO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4047
Mailing Address - Country:US
Mailing Address - Phone:630-784-7010
Mailing Address - Fax:630-268-9639
Practice Address - Street 1:832 E WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4047
Practice Address - Country:US
Practice Address - Phone:630-784-7010
Practice Address - Fax:630-268-9639
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-003592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer