Provider Demographics
NPI:1235638909
Name:DAVILLI-THOMSON, CHRISTINA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:DAVILLI-THOMSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STRATTON FARMS RD
Mailing Address - Street 2:
Mailing Address - City:WEST SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-2925
Mailing Address - Country:US
Mailing Address - Phone:413-530-1654
Mailing Address - Fax:
Practice Address - Street 1:1 TOWER SQ
Practice Address - Street 2:4GS
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06183-0001
Practice Address - Country:US
Practice Address - Phone:860-246-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist