Healthcare Provider Details

I. General information

NPI: 1225630981
Provider Name (Legal Business Name): CHRISTINA A FRATTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 GOLD STAR HWY UNIT 201
MYSTIC CT
06355-1180
US

IV. Provider business mailing address

2440 GOLD STAR HWY
MYSTIC CT
06355-1180
US

V. Phone/Fax

Practice location:
  • Phone: 860-536-1001
  • Fax:
Mailing address:
  • Phone: 860-536-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12868
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1267
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: