Basic Information
| Provider Information | |||||||||
| NPI: | 1386887495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURKEE | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 PATRICIA M. GENOVA DRIVE | ||||||||
| Address2: | EASTERN REHABILITATION NETWORK 5TH FLOOR | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606675480 | ||||||||
| FaxNumber: | 8606678416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1064 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032359622 | ||||||||
| FaxNumber: | 2036303600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 04/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 008522 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004212362 | 05 | CT | MEDICAID | 076536 | 01 | CT | MEDICARE | OTHER |