Healthcare Provider Details

I. General information

NPI: 1811015159
Provider Name (Legal Business Name): MARIA FATIMA CARRASCO PLITZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 W DIANA AVE
GLENDALE AZ
85302-5125
US

IV. Provider business mailing address

8 HOPEWELL HTS
SOUTH GLASTONBURY CT
06073-2402
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-5244
  • Fax:
Mailing address:
  • Phone: 860-430-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007608
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: