MEDICARE: MRS. AMY ELIZABETH DEAN MSPT

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	005642	CT

General Provider Information

NPI Number	:	1538439682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY ELIZABETH DEAN MSPT

Provider Business Mailing Address
First Line	:	135 BARTLETT ST
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1229
Country	:	US
Telephone Number	:	860-342-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MAIN ST
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1561
Country	:	US
Telephone Number	:	860-342-0370
Fax Number	:

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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