Provider Demographics
NPI:1609979400
Name:KIMBERLY I MEYER-PELLETIER
Entity Type:Organization
Organization Name:KIMBERLY I MEYER-PELLETIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER-PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-456-3772
Mailing Address - Street 1:10 HIGGINS HWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-3772
Mailing Address - Fax:860-456-4941
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-3772
Practice Address - Fax:860-456-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080003871CT01OtherBC
CT650000341Medicare ID - Type Unspecified