Basic Information
| Provider Information | |||||||||
| NPI: | 1205973625 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIRGINIA M. CIOCHETTI, PT, ATC, PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PHYSICAL THERAPY AND SPORTS MEDICINE CENTER OF SOUTHBURY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CIOCHETTI | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2032641735 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.