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General NPI Number Information
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NPI Number | 1629748942
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Entity Type | Individual
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Provider Name | SUSAN WADLEIGH
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Gender | Female
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | BRADLEY HOME 320 COLONY ST
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City | MERIDEN
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State | CT
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Zip | 06451
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Country | US
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Telephone | 203-235-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 77 KELSEY LN
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City | GLASTONBURY
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State | CT
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Zip | 06033-5040
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Country | US
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Telephone | 860-430-9321
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 14.004293
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License Number State | CT
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