Provider Demographics
NPI:1639319510
Name:FUSCO, PATRICIA G
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:G
Last Name:FUSCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COBBLER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2686
Mailing Address - Country:US
Mailing Address - Phone:203-262-8266
Mailing Address - Fax:
Practice Address - Street 1:1449 OLD WATERBURY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-262-9909
Practice Address - Fax:203-262-9911
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics