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General NPI Number Information
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NPI Number | 1841587086
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Entity Type | Individual
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Provider Name | RENA MULLER MANTEGAZZA PT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 13 PARK LAWN DR
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City | BETHEL
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State | CT
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Zip | 06801-1043
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Country | US
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Telephone | 203-830-4180
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Fax | 203-797-2995
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Provider Business Mailing Address
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Address Line | 38 MADELINE DR
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City | RIDGEFIELD
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State | CT
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Zip | 06877-2209
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Country | US
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Telephone | 203-438-0343
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 003292
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License Number State | CT
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