Healthcare Provider Details

I. General information

NPI: 1295851715
Provider Name (Legal Business Name): JESSICA A SUOMALA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 OXFORD RD
OXFORD CT
06478-1982
US

IV. Provider business mailing address

111 WAKELEE AVE
ANSONIA CT
06401-1151
US

V. Phone/Fax

Practice location:
  • Phone: 203-881-5266
  • Fax: 203-881-5264
Mailing address:
  • Phone: 203-734-7900
  • Fax: 203-734-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006908
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: