Healthcare Provider Details

I. General information

NPI: 1194786236
Provider Name (Legal Business Name): RICHARD T DICARLO RPT, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COMMERCE PARK
MILFORD CT
06460-3551
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-0479
  • Fax: 203-865-6788
Mailing address:
  • Phone: 203-626-0160
  • Fax: 203-294-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number006115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: