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NPI Code Detail

MEDICARE: MRS. SUSAN DELAURENTIS RPT

MEDICARE: MRS. SUSAN DELAURENTIS 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
1225100000XPhysical Therapist001303CT

General Provider Information

NPI Number : 1922385251
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN DELAURENTIS RPT
Provider Business Mailing Address
First Line : 251 SUMMER HILL RD
Second Line :
City : MADISON
State : CT
Zip : 06443-1850
Country : US
Telephone Number : 203-421-3490
Fax Number :
Provider Business Practice Location Address
First Line : 1775 BOSTON POST RD
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-1643
Country : US
Telephone Number : 860-399-6216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2011
Last Update Date : 11/15/2011

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