Provider Demographics
NPI:1073220265
Name:DENEGAR, SUSAN ESPER (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ESPER
Last Name:DENEGAR
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 WORMWOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1145
Mailing Address - Country:US
Mailing Address - Phone:860-823-7727
Mailing Address - Fax:
Practice Address - Street 1:14 CLUB RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06280-1000
Practice Address - Country:US
Practice Address - Phone:860-456-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist