Provider Demographics
NPI:1437675857
Name:GIRAO, MARCELLO (CO CPED)
Entity type:Individual
Prefix:MR
First Name:MARCELLO
Middle Name:
Last Name:GIRAO
Suffix:
Gender:M
Credentials:CO CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10285 CHAMPION FARMS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6150
Mailing Address - Country:US
Mailing Address - Phone:502-425-1172
Mailing Address - Fax:
Practice Address - Street 1:10285 CHAMPION FARMS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6150
Practice Address - Country:US
Practice Address - Phone:502-425-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164584222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist