Healthcare Provider Details

I. General information

NPI: 1932024551
Provider Name (Legal Business Name): LUCCA ARDOVINI-BROOKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 IVY BROOK RD STE 230
SHELTON CT
06484-6416
US

IV. Provider business mailing address

32 CLAPP HILL RD
LAGRANGEVILLE NY
12540-6365
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-2853
  • Fax: 203-924-2865
Mailing address:
  • Phone: 203-924-2853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15599
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: