Provider Demographics
NPI:1235455049
Name:SANSONE, MORGANE DOMINIQUE (DPT)
Entity Type:Individual
Prefix:
First Name:MORGANE
Middle Name:DOMINIQUE
Last Name:SANSONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7812
Mailing Address - Country:US
Mailing Address - Phone:203-450-1034
Mailing Address - Fax:
Practice Address - Street 1:7003 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1393
Practice Address - Country:US
Practice Address - Phone:203-395-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist