MEDICARE: MITCHELL TEODOSIO SASIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	040907	NY
2	225100000X	Physical Therapist	11702	CT

General Provider Information

NPI Number	:	1255008694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL TEODOSIO SASIS

Provider Business Mailing Address
First Line	:	7345 WOODLAND DR STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1737
Country	:	US
Telephone Number	:	317-388-0800
Fax Number	:	317-388-0805

Provider Business Practice Location Address
First Line	:	123 RICHARDS AVE
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06854-1611
Country	:	US
Telephone Number	:	203-523-0510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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Directions to “ MITCHELL TEODOSIO SASIS ” Practice Location

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