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General NPI Number Information
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NPI Number | 1639319510
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Entity Type | Individual
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Provider Name | MRS. PATRICIA G FUSCO
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Gender | Female
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 1449 OLD WATERBURY RD SUITE 104
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City | SOUTHBURY
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State | CT
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Zip | 06488-3926
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Country | US
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Telephone | 203-262-9909
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Fax | 203-262-9911
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Provider Business Mailing Address
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Address Line | 245 COBBLER LN
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City | SOUTHBURY
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State | CT
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Zip | 06488-2686
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Country | US
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Telephone | 203-262-8266
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 005027
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License Number State | CT
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