Provider Demographics
NPI:1063462158
Name:DAROSA, EVE J (MPT)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:J
Last Name:DAROSA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-1700
Mailing Address - Fax:203-637-5447
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-1700
Practice Address - Fax:203-637-5447
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0800007338CT01OtherBLUE CROSS BLUE SHIELD ID