Provider Demographics
NPI:1063466480
Name:ZUJEWSKI, RENATA A (MSPT)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:A
Last Name:ZUJEWSKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-621-7389
Mailing Address - Fax:860-621-2586
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-621-7389
Practice Address - Fax:860-621-2586
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004252178Medicaid
CT650001119Medicare PIN