Provider Demographics
NPI:1275753451
Name:OUELLETTE, ROBBIE (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBBIE
Middle Name:
Last Name:OUELLETTE
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 1:116 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3130
Mailing Address - Country:US
Mailing Address - Phone:860-261-5211
Mailing Address - Fax:
Practice Address - Street 1:116 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3130
Practice Address - Country:US
Practice Address - Phone:860-261-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 005592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist