Provider Demographics
NPI:1508301540
Name:BARBAGALLO, LAURA SUE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:SUE
Last Name:BARBAGALLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:SUE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:109 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2303
Mailing Address - Country:US
Mailing Address - Phone:203-268-8810
Mailing Address - Fax:
Practice Address - Street 1:238 MONROE TPKE UNIT A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-6200
Practice Address - Country:US
Practice Address - Phone:203-261-6500
Practice Address - Fax:203-261-6507
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist