Provider Demographics
NPI:1225264971
Name:KISHELOVA, ELEONORA S (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:S
Last Name:KISHELOVA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 E PUTNAM AVE
Mailing Address - Street 2:BUILDING 2, SECOND FLOOR
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1426
Mailing Address - Country:US
Mailing Address - Phone:203-637-1700
Mailing Address - Fax:203-637-5447
Practice Address - Street 1:1171 E PUTNAM AVE
Practice Address - Street 2:BUILDING 2, SECOND FLOOR
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1426
Practice Address - Country:US
Practice Address - Phone:203-637-1700
Practice Address - Fax:203-637-5447
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008544225100000X
MI5501014394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist