MEDICARE: MICHELE GRASSO RPT

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	004600	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080004600CT03	OTHER	CT	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5360125	OTHER	CT	AETNA
4	68562	OTHER	CT	OXFORD/ORTHONET
5	15701	OTHER	CT	CIGNA/ORTHONET

General Provider Information

NPI Number	:	1598715054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE GRASSO RPT

Provider Business Mailing Address
First Line	:	PO BOX 619
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-0619
Country	:	US
Telephone Number	:	860-345-2622
Fax Number	:	860-345-2626

Provider Business Practice Location Address
First Line	:	3A CANDLEWOOD HILL ROAD
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4202
Country	:	US
Telephone Number	:	860-345-2622
Fax Number	:	860-345-2626

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/05/2015

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Directions to “ MICHELE GRASSO RPT” Practice Location

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