Healthcare Provider Details

I. General information

NPI: 1639193386
Provider Name (Legal Business Name): LOUIS M PERROTTA CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DOWD AVE
CANTON CT
06019-2401
US

IV. Provider business mailing address

141 DOWD AVE
CANTON CT
06019-2401
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-6932
  • Fax:
Mailing address:
  • Phone: 860-693-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: