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General NPI Number Information
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NPI Number | 1497542468
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Entity Type | Individual
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Provider Name | LISA D FIASCONARO
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 1715 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2707
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Country | US
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Telephone | 860-644-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 4 DAISY LN
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City | ELLINGTON
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State | CT
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Zip | 06029-3240
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Country | US
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Telephone | 860-416-9986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 001835
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License Number State | CT
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