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General NPI Number Information
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NPI Number | 1720055239
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Entity Type | Individual
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Provider Name | MICHELLE M MAIORINO DPT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 7 PARK AVE
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City | COLCHESTER
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State | CT
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Zip | 06415-1128
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Country | US
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Telephone | 860-531-3222
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Fax | 860-531-3224
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Provider Business Mailing Address
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Address Line | 7 PARK AVE
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City | COLCHESTER
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State | CT
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Zip | 06415-1128
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Country | US
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Telephone | 860-537-6798
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Fax | 860-531-3224
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008104
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License Number State | CT
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