Provider Demographics
NPI:1255476313
Name:MASTRIANNI, ROBERT J (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MASTRIANNI
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 1:8 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1929
Mailing Address - Country:US
Mailing Address - Phone:203-294-1998
Mailing Address - Fax:203-294-1189
Practice Address - Street 1:8 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1929
Practice Address - Country:US
Practice Address - Phone:203-294-1998
Practice Address - Fax:203-294-1189
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3430225100000X, 2251E1200X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT712712OtherCONNECTICARE
CT080003430CT13OtherANTHEM BCBS
CT183158OtherFIRST CHOICE
CT6404254OtherUNITED HEALTHCARE
CT0V1691OtherHEALTHNET
CT1182831OtherAETNA
CTA667399OtherOXFORD
076561Medicare ID - Type Unspecified