Healthcare Provider Details

I. General information

NPI: 1780784959
Provider Name (Legal Business Name): MRS. MAUREEN MUNSON-BETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN ST S STE 200
WOODBURY CT
06798-3407
US

IV. Provider business mailing address

264 MAIN ST S STE 200
WOODBURY CT
06798-3407
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-0002
  • Fax: 203-263-0090
Mailing address:
  • Phone: 203-263-0002
  • Fax: 23-263-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1680
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: