Healthcare Provider Details

I. General information

NPI: 1033306311
Provider Name (Legal Business Name): REBECCA LYNNE PETROSINO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORPORATE DR STE 2-2
TRUMBULL CT
06611-1351
US

IV. Provider business mailing address

15 CORPORATE DR STE 2-2
TRUMBULL CT
06611-1351
US

V. Phone/Fax

Practice location:
  • Phone: 203-220-6712
  • Fax:
Mailing address:
  • Phone: 203-220-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11695
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: