Provider Demographics
NPI:1558411173
Name:LIONETTI, CANDIDA (PTA)
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:LIONETTI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4771
Mailing Address - Country:US
Mailing Address - Phone:203-481-6221
Mailing Address - Fax:
Practice Address - Street 1:189 ALPS RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4771
Practice Address - Country:US
Practice Address - Phone:203-481-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000326225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant