Provider Demographics
NPI:1346514445
Name:PANTASON, DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PANTASON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3339
Mailing Address - Country:US
Mailing Address - Phone:860-979-1600
Mailing Address - Fax:203-866-3014
Practice Address - Street 1:9B FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3421
Practice Address - Country:US
Practice Address - Phone:860-870-9800
Practice Address - Fax:860-870-9804
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant