Healthcare Provider Details

I. General information

NPI: 1215497706
Provider Name (Legal Business Name): JACQUELINE MOSCARELLI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 BOSTON POST RD
GUILFORD CT
06437-1467
US

IV. Provider business mailing address

3 ANDREWS RD
ESSEX CT
06426-1311
US

V. Phone/Fax

Practice location:
  • Phone: 203-458-1000
  • Fax:
Mailing address:
  • Phone: 203-710-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004947
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number004947
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: