Healthcare Provider Details

I. General information

NPI: 1700798980
Provider Name (Legal Business Name): BEN FAMIGLIETTI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 E MAIN ST
MERIDEN CT
06450-4898
US

IV. Provider business mailing address

39 SHEA CIR
ROCKY HILL CT
06067-1938
US

V. Phone/Fax

Practice location:
  • Phone: 203-235-9622
  • Fax:
Mailing address:
  • Phone: 860-948-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15628
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: