Provider Demographics
NPI:1497914626
Name:BEDSON, MARY KISSEBERTH (RPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KISSEBERTH
Last Name:BEDSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MCCABE
Other - Last Name:KISSEBERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 BEACH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-255-7000
Mailing Address - Fax:203-255-6995
Practice Address - Street 1:52 BEACH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6017
Practice Address - Country:US
Practice Address - Phone:203-255-7000
Practice Address - Fax:203-255-6995
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist