MEDICARE: EILEEN MARKHAM BARRECA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	005771	CT

General Provider Information

NPI Number	:	1659910107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARKHAM BARRECA DPT

Provider Business Mailing Address
First Line	:	126 MONROE TPKE STE 210
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	781-492-4991
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 MONROE TPKE STE 210
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	781-492-4991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	01/02/2020

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