Healthcare Provider Details

I. General information

NPI: 1043475098
Provider Name (Legal Business Name): MATTHEW CALENDRILLO DPT, BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 BRIDGE STREET SUITE 111
SUFFIELD CT
06078-3107
US

IV. Provider business mailing address

68 BRIDGE ST SUITE 111
SUFFIELD CT
06078-3107
US

V. Phone/Fax

Practice location:
  • Phone: 860-254-5190
  • Fax: 860-254-5190
Mailing address:
  • Phone: 860-254-5190
  • Fax: 860-254-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24148
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number007740
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: