Healthcare Provider Details

I. General information

NPI: 1548445745
Provider Name (Legal Business Name): TATIANA N DUPERE RPT REGISTERED PHYSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WATERBURY ROAD RIFKIN PHYSICAL THERAPY AND LYMPHEDEMA CENTER LLC
PROSPECT CT
06712-1482
US

IV. Provider business mailing address

470 PINEWOOD DRIVE
LONGMEADOW MA
01106-1644
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-6569
  • Fax: 203-758-0443
Mailing address:
  • Phone: 413-567-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006528
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15050
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: