Provider Demographics
NPI:1043542657
Name:JACQUET, LETICIA (MSPT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:JACQUET
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:MONTEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT, DPT
Mailing Address - Street 1:1022 BOULEVARD
Mailing Address - Street 2:#274
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-251-9754
Mailing Address - Fax:
Practice Address - Street 1:1022 BOULEVARD
Practice Address - Street 2:#274
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-251-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009290225100000X
NY0-30043-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist