Provider Demographics
NPI:1043475098
Name:CALENDRILLO, MATTHEW (DPT, BOCO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:CALENDRILLO
Suffix:
Gender:M
Credentials:DPT, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRIDGE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-3107
Mailing Address - Country:US
Mailing Address - Phone:860-254-5190
Mailing Address - Fax:860-254-5190
Practice Address - Street 1:68 BRIDGE STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-3107
Practice Address - Country:US
Practice Address - Phone:860-254-5190
Practice Address - Fax:860-254-5190
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24148225100000X
CT007740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0522/1982OtherBIRTHDATE