Provider Demographics
NPI:1598931057
Name:ANSELMO, LOUISE MARIE (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:MARIE
Last Name:ANSELMO
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W MAIN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4501
Mailing Address - Country:US
Mailing Address - Phone:203-967-3200
Mailing Address - Fax:203-967-3800
Practice Address - Street 1:2001 W MAIN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4501
Practice Address - Country:US
Practice Address - Phone:203-967-3200
Practice Address - Fax:203-967-3800
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist