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General NPI Number Information
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NPI Number | 1649488644
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Entity Type | Organization
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Legal Business Name | ST RAPHAEL'S HOSPITAL
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 84 N MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3009
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Country | US
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Telephone | 203-789-5120
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Fax | 203-488-7129
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Provider Business Mailing Address
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Address Line | 84 N MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3009
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Country | US
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Telephone | 203-789-5120
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Fax | 203-488-7129
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JOSEPH MARTUCCI
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Credential | PT
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Telephone | 203-789-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 007226
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License Number State | CT
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