Healthcare Provider Details

I. General information

NPI: 1104690783
Provider Name (Legal Business Name): STEPHANIE FOLLETTE DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILL PLAIN RD
FAIRFIELD CT
06824-5048
US

IV. Provider business mailing address

57 TWITCHGRASS RD
TRUMBULL CT
06611-4636
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-3573
  • Fax:
Mailing address:
  • Phone: 203-554-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number009014
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: