Provider Demographics
NPI:1598028789
Name:ABELLO, MARICON
Entity type:Individual
Prefix:
First Name:MARICON
Middle Name:
Last Name:ABELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD
Mailing Address - Street 2:APT 206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3234
Mailing Address - Country:US
Mailing Address - Phone:808-285-1042
Mailing Address - Fax:
Practice Address - Street 1:5800 W SAMPLE RD
Practice Address - Street 2:APT 206
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3234
Practice Address - Country:US
Practice Address - Phone:808-285-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021993225100000X
NY034821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist