Individual
DIANE KAY MARCELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
211 S CURTIS ST, LAKE GENEVA, WI 53147-2052
(262) 248-3145
Mailing address
W5473 BARLEY RD, ELKHORN, WI 53121-3451
(262) 742-4773
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
962-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316170814
—
WI
Enumeration date
08/31/2009
Last updated
10/15/2012
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