MEDICARE: MS. MARISA Q VILHENA PT

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	261QP2000X	Physical Therapy Clinic/Center	6282	CT

General Provider Information

NPI Number	:	1508984717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISA Q VILHENA PT

Provider Business Mailing Address
First Line	:	460 PETER RD
Second Line	:
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-4610
Country	:	US
Telephone Number	:	203-264-0684
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 MAIN ST
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06614-4960
Country	:	US
Telephone Number	:	203-430-1648
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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