Healthcare Provider Details

I. General information

NPI: 1275960569
Provider Name (Legal Business Name): MR. MICHAEL ANGELO CIOTTO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 HARRINGTON CT
COLCHESTER CT
06415-1207
US

IV. Provider business mailing address

336 CENTER RD 23 B
VERNON CT
06066-4179
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-2339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001326
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: