Provider Demographics
NPI:1295000313
Name:RACCIO, FRANK JAMES JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JAMES
Last Name:RACCIO
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2377
Mailing Address - Country:US
Mailing Address - Phone:860-395-2990
Mailing Address - Fax:203-386-1144
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2377
Practice Address - Country:US
Practice Address - Phone:603-952-9908
Practice Address - Fax:203-386-1144
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant