Provider Demographics
NPI:1548386469
Name:MACRITCHIE, ROBERTA (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MACRITCHIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3605
Mailing Address - Country:US
Mailing Address - Phone:203-393-2598
Mailing Address - Fax:203-393-3360
Practice Address - Street 1:1261 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1720
Practice Address - Country:US
Practice Address - Phone:860-628-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist