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NPI Code Detail

MEDICARE: SUSAN PEPE

MEDICARE: SUSAN PEPE
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
1225100000XPhysical Therapist1684CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111244001OTHERCTCAQH
2XV4914OTHERCTHEALTHNET
3080001684CT02OTHERCTBLUE HEALTHCARE INSURANCE

General Provider Information

NPI Number : 1528182698
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN PEPE
Provider Business Mailing Address
First Line : 75 NORTON RD
Second Line :
City : KENSINGTON
State : CT
Zip : 06037-2918
Country : US
Telephone Number : 860-828-3956
Fax Number :
Provider Business Practice Location Address
First Line : 45 MERIDEN AVE
Second Line :
City : SOUTHINGTON
State : CT
Zip : 06489-3214
Country : US
Telephone Number : 860-378-1234
Fax Number : 860-378-1160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN PEPE ” Practice Location

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