Provider Demographics
NPI:1558676775
Name:DEPALMA, ELIZABETH A (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DEPALMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SUERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-407-3590
Mailing Address - Fax:203-407-3595
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-288-5913
Practice Address - Fax:203-752-9291
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008854225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008854OtherCT LICENSE
CT008854OtherCT LICENSE
DEP01038054OtherMEDICARE RAILROAD