Healthcare Provider Details

I. General information

NPI: 1043575517
Provider Name (Legal Business Name): ERIC MEOLI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BOSTON POST RD STE 5A
GUILFORD CT
06437-2733
US

IV. Provider business mailing address

145 SORRENTO AVE
EAST HAVEN CT
06512-4225
US

V. Phone/Fax

Practice location:
  • Phone: 203-458-1645
  • Fax: 203-458-1689
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14.009464
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: