Provider Demographics
NPI:1225164643
Name:PETIT, LAURA L (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:PETIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2111
Mailing Address - Country:US
Mailing Address - Phone:203-637-8543
Mailing Address - Fax:
Practice Address - Street 1:500 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6086
Practice Address - Country:US
Practice Address - Phone:203-869-5546
Practice Address - Fax:203-629-4836
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist