Provider Demographics
NPI:1043578149
Name:MERCUGLIANO, JUDITH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:MERCUGLIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1674
Mailing Address - Country:US
Mailing Address - Phone:203-699-1265
Mailing Address - Fax:
Practice Address - Street 1:50 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1674
Practice Address - Country:US
Practice Address - Phone:203-699-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist