Provider Demographics
NPI:1558352815
Name:PHILIP, PETER A (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:PHILIP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SZOST DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4041
Mailing Address - Country:US
Mailing Address - Phone:203-362-1241
Mailing Address - Fax:
Practice Address - Street 1:42 VITTI ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4823
Practice Address - Country:US
Practice Address - Phone:203-966-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist