Healthcare Provider Details

I. General information

NPI: 1295818920
Provider Name (Legal Business Name): ANTONIO R ESPOSITO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KNOTTER DR # 303-36 PRATT AND WHITNEY
CHESHIRE CT
06410-1140
US

IV. Provider business mailing address

28 BELVEDERE RD
NORTH HAVEN CT
06473-3913
US

V. Phone/Fax

Practice location:
  • Phone: 203-250-4444
  • Fax:
Mailing address:
  • Phone: 203-234-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2445
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: