Healthcare Provider Details

I. General information

NPI: 1043300338
Provider Name (Legal Business Name): DONNA M. LEDDY RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA CREMIN

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST S SUITE 212
SOUTHBURY CT
06488-4240
US

IV. Provider business mailing address

22 TOMPKINS STREET
WATERBURY CT
06708-1458
US

V. Phone/Fax

Practice location:
  • Phone: 203-262-4603
  • Fax:
Mailing address:
  • Phone: 203-419-0381
  • Fax: 203-419-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004691
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: