Provider Demographics
NPI:1053465237
Name:HOUSE, JANE (RPT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COTTAGE GROVE RD
Mailing Address - Street 2:E130
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3059
Mailing Address - Country:US
Mailing Address - Phone:860-286-0838
Mailing Address - Fax:860-286-0109
Practice Address - Street 1:701 COTTAGE GROVE RD
Practice Address - Street 2:SUITE E130
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3059
Practice Address - Country:US
Practice Address - Phone:860-286-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT074511Medicare ID - Type Unspecified