Healthcare Provider Details

I. General information

NPI: 1366920639
Provider Name (Legal Business Name): JAMES DEANDRESSI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

800 POST RD STE 3A
DARIEN CT
06820-4622
US

V. Phone/Fax

Practice location:
  • Phone: 203-672-9227
  • Fax: 203-889-4824
Mailing address:
  • Phone: 203-202-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1929
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: