Provider Demographics
NPI:1225074792
Name:FELICONIO, THOMAS D (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:FELICONIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 HANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3329
Mailing Address - Country:US
Mailing Address - Phone:203-612-6225
Mailing Address - Fax:203-612-6225
Practice Address - Street 1:56 HANFORD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3329
Practice Address - Country:US
Practice Address - Phone:203-612-6225
Practice Address - Fax:203-612-6225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist