Provider Demographics
NPI:1083600688
Name:LIBERATORE, JEROME LOUIS (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:LOUIS
Last Name:LIBERATORE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 MAIN ST
Mailing Address - Street 2:PETER S ZIELINSKI PHYSICAL THERAPY PC
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1110
Mailing Address - Country:US
Mailing Address - Phone:203-445-9843
Mailing Address - Fax:203-445-9847
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:PETER S ZIELINSKI PHYSICAL THERAPY PC
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1110
Practice Address - Country:US
Practice Address - Phone:203-445-9843
Practice Address - Fax:203-445-9847
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2747830OtherAETNA
2V5870OtherHEALTH NET FACILITY #
37901OtherORTHONET CIGNA GRP #
P2122523OtherOXFORD
9906497OtherCIGNA GROUP #