Provider Demographics
NPI:1558498931
Name:CONNELL - GIAMMATTEO, AYELET (PT)
Entity Type:Individual
Prefix:
First Name:AYELET
Middle Name:
Last Name:CONNELL - GIAMMATTEO
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 1:800 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3064
Mailing Address - Country:US
Mailing Address - Phone:860-243-6571
Mailing Address - Fax:860-243-6579
Practice Address - Street 1:800 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3064
Practice Address - Country:US
Practice Address - Phone:860-243-6571
Practice Address - Fax:860-243-6579
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006813225100000X
NC9292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001076Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NC250217Medicare PIN