Provider Demographics
NPI:1063008936
Name:FORTI, MARISA I (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:FORTI
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:FORTI
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:840 FARMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4216
Mailing Address - Country:US
Mailing Address - Phone:860-604-6068
Mailing Address - Fax:
Practice Address - Street 1:840 FARMINGTON DR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4216
Practice Address - Country:US
Practice Address - Phone:860-604-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT29.006813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist