Provider Demographics
NPI:1588336093
Name:WILLIAM, MARICELLA JAHAIRA (DPT)
Entity type:Individual
Prefix:
First Name:MARICELLA
Middle Name:JAHAIRA
Last Name:WILLIAM
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 1:10547 PEPPERGRASS CT.
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-947-2128
Mailing Address - Fax:
Practice Address - Street 1:10547 PEPPERGRASS CT.
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-947-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist