Healthcare Provider Details

I. General information

NPI: 1386959690
Provider Name (Legal Business Name): PETER N VISGILIO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HARTFORD TPKE
VERNON CT
06066-4852
US

IV. Provider business mailing address

435 HARTFORD TPKE SUITE U
VERNON CT
06066-4852
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-8272
  • Fax: 860-875-0804
Mailing address:
  • Phone: 860-979-1611
  • Fax: 203-866-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003346
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: