Provider Demographics
NPI:1508533159
Name:FETKO, LAURA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FETKO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4306
Mailing Address - Country:US
Mailing Address - Phone:860-679-0430
Mailing Address - Fax:
Practice Address - Street 1:302 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4306
Practice Address - Country:US
Practice Address - Phone:860-679-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist