Healthcare Provider Details

I. General information

NPI: 1699720474
Provider Name (Legal Business Name): MICHELLE PUZZO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE BUSSIERE PT

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERROW RD UNIT 2
TOLLAND CT
06084-3416
US

IV. Provider business mailing address

31 OLD ROUTE 7 ATTN: CREDENTIALING DEPT
BROOKFIELD CT
06804-1714
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-8357
  • Fax: 860-872-8397
Mailing address:
  • Phone: 203-740-0020
  • Fax: 203-775-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006545
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: