Basic Information
| Provider Information | |||||||||
| NPI: | 1528549821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERROTTI | ||||||||
| FirstName: | LINDSEY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HARTFORD TPKE STE U | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608708272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 MAIN ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | ELLINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060293361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608727500 | ||||||||
| FaxNumber: | 8608727501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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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 | 011956 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 011956 | 01 | CT | CT LICENSE | OTHER |