Provider Demographics
NPI:1215484076
Name:PICARELLA, KRISTOPHER (ATC)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:
Last Name:PICARELLA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:KIP
Other - Middle Name:
Other - Last Name:PICARELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:711 WAILEPO PL
Mailing Address - Street 2:APT 103
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 WAILEPO PL
Practice Address - Street 2:APT 103
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2609
Practice Address - Country:US
Practice Address - Phone:903-475-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT2612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer