Provider Demographics
NPI:1487942231
Name:CARDARELLI, MARY NEUBELT
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:NEUBELT
Last Name:CARDARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:NEUBELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, AT,C
Mailing Address - Street 1:74 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2870
Mailing Address - Country:US
Mailing Address - Phone:860-646-5856
Mailing Address - Fax:
Practice Address - Street 1:22 SOUTH ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4553
Practice Address - Country:US
Practice Address - Phone:860-875-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004655225100000X
CT0000912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer